RYLA Participant Registration Spring 2024
First Name  *
Last Name *
Date of Birth (M/D/Y)  *
Gender *
Age *
Prefered Name (Nickname/Name You Want to Be Called) *
Your Phone Number *
Your Email *
Parent's Phone Number  *
Parent's Email *
Address *
City  *
State *
Zipcode *
Shirt Size  *
High School *
Grade (Sophmore, Junior, or Senior) *
Are you a member of an Interact Club?
 *
Insurance Company 
 *
Medical Insurance Policy Number *
Name of Insured (First and Last) *
Emergency Contact Phone Number #1, First and Last Name, Relationship to Participant *
Emergency Contact Phone Number #2 (Not Required) First and Last Name, Relationship to Participant
Medications (If none say "None") *
Allergy or allergies (If none say "None")
 *
Vegetarian
 *
Dietary restriction and/or food allergy (If none say "None")
 *
Sponsoring Organization (Rotary club, Interact club, Boy and Girls Club, Coast Guard, etc) If none say "None"
 *
Contact Email Address for the Sponsoring Organization (If none say "None")
 *
Please share the name of a RYLA facilitator that referred you to RYLA (If none say "None")
 *
I acknowledge RYLA is being held at a YMCA camp. We’re not responsible for cold, hot or wet weather conditions so you need to be prepared for all forms of weather. (Please type your initials below if you acknowledge this) *
You’ve Now Completed Your RYLA Application! Acceptance letters will be sent on or before the application due date two weeks prior to the conference. Any questions contact:

7980ryla@gmail.com
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