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.
RYLA Participant Forms are due by March 1, 2020.
Please note: Once this form is submitted, your selected participant will receive an email with their participant packet. This packet must be completed, notariazed, and returned by April 1.
Student Information:
First Name: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Last Name: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name for Badge (i.e. Nickname) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Age: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Student Home Phone Number: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Student Cell Phone Number: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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State: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Zip Code: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Student Email Address: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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High School Attending: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parents'/Guardians' Names: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent/Guardian Home Phone: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent/Guardian Cell Phone: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent/Guardian Work Phone: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Parent Email Address: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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T-Shirt Size (In Mens): {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Other Meal Considerations (please describe): {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Rotarian Sponsor Name: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Rotary Club: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Rotarian Best Contact Phone Number: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Rotarian Email: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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