RYLA Participant Form
Dear Rotarians,
Please fill out the personal information for your selected RYLA participant. Note: If you have multiple students, they will need to be submitted separately.
You also need to fill out the Rotarian Sponsor section. This section is designated for the person your club chooses to be the liaison for RYLA. Once all required fields are completed please click the "Submit" button below to receive your confirmation.
Your submission will result in your club being billed by Rotary District 6970 for each RYLA participant.
RYLA Participant Forms are due by April 1, 2019.
This year's RYLA is tentatively scheduled for June 13-16 at Stetson University.
Student Information:
First Name:
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Last Name:
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Name for Badge (i.e. Nickname)
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Age:
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Student Home Phone Number:
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Student Cell Phone Number:
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Address:
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City
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State:
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Zip Code:
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Student Email Address:
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High School Attending:
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Parents'/Guardians' Names:
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Parent/Guardian Home Phone:
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Parent/Guardian Cell Phone:
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Parent/Guardian Work Phone:
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Parent Email Address:
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T-Shirt Size (In Mens):
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Other Meal Considerations (please describe):
Rotarian Sponsor Name:
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Rotary Club:
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Rotarian Daytime Phone:
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Rotarian Evening Phone:
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Rotarian Email:
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