2026 Fall RYLA Registration - District 7980 
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Participant Information
First Name *
Last Name *
Date of Birth *
Date
Gender *
Age *
Preferred Name / Nickname *
Phone number *
Email *
Parent / Guardian Information
Parent/Guardian Name & Phone Number *
Parent/Guardian Email *
Home Address (street, city, state, ZIP) *
Shirt Size *
School & Interact
High School *
Grade *
Are you a member of an Interact Club? *
Do you hold a leadership position in an Interact Club? *
Medical & Emergency Information
Insurance Company *
Medical Insurance Policy Number *
Name of Insured (First and Last) *
Emergency Contact #1: name, phone number, and relationship to participant *
Emergency Contact #2: name, phone number, and relationship to participant *
Allergies and Medications (enter "None" if not applicable) *
Dietary Restrictions / Food Allergies (enter "None" if not applicable) *
RYLA Sponsorship
RYLA participation must be sponsored by a Rotary Club, school, family, civic organization, or other approved sponsor. Enter the sponsoring organization or individual. *
Registration Fee Payment Status *
Sponsor Contact Email and Phone Number *
Name of the RYLA facilitator, sponsor, or advisor who referred you (enter "None" if applicable) *
Participant Acknowledgment
Participant acknowledgment: I understand the RYLA location, schedule, and that some activities may be outdoors. I will prepare for expected weather and appropriate clothing/footwear. Type your full name to acknowledge. *
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