2026 RYLA Registration Form

2026 RYLA Registration Form

You are applying for the 2026 Rotary District 7390 RYLA Conference. The Conference will be held Sunday, June 7 to Thursday, June 11, 2026 at Messiah University in Mechanicsburg. I understand that by applying, I am committing to attending the ENTIRE Conference from START on June 7 to CLOSING on June 11!
Name*

First NameLast Name
Name you wish to be called (Ex - a nickname like Dave instead of David)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
MaleFemale
SmallMediumLargeExtra LargeXX LargeXXX Large
Color Headshot for Program Book*

Cancelof
Name of High School you Attend*
YesNo
If yes, what instrument will you bring?
YesNo
AltoSopranoTenorBass
National Honor SocietyClass OfficerStudent Council OfficerInteract ClubEditor School NewspaperEditor in Chief of School YearbookCaptain or Co-Captain of a Sports TeamOfficer of Any Musical GroupOfficer of Any Club or School OrganizationPeer/Counselor Tutor
BaseballBasketballField HockeyFootballGolfLacrosseSoccerSwimmingTennisTrack & FieldVolleyballWrestlingOther
Scouting LeadershipAmerica Red CrossCancer SocietyFood PantryChurch/Synagogue/Mosque Youth LeaderVacation Bible SchoolTeach in Church SchoolChildren's Center/Day CareCamp CounselorRecreational Role4-HFFAPeer Mentor/Peer TeacherOther
School Subjects (List those courses in which you excel)
Hobbies or Areas of Special Interest
List Allergies or Special Medical Needs that would be relevant to the Conference:*
Legal Guardian #1 *

First NameLast Name
Legal Guardian #1 - Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
Legal Guardian #1 - Email Address*
example@example.com
Legal Guardian #2

First NameLast Name
Legal Guardian #2 - Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Legal Guardian #2 - Email Address
example@example.com
In Case of Emergency, my child may be released to: Please list the names of 3 adults and provide their phone #s.*
CarlisleCarlisle-SunriseColonial ParkD7390 PassportDenver-EphrataDonegalEastern Lancaster CountyEastern York CountyElizabethtownGettysburgHanoverHarrisburgHarrisburg-KeystoneHersheyHummelstownLancasterLancaster-HempfieldLancaster Penn SquareLancaster-SouthLancaster-SunriseLebanonLititzLittlestownManheimMechanicsburg-NorthMillersburgMount JoyMyerstown-ELCONorthern Lebanon CountyPalmyraParadisePerry CountyRed Lion/Dallastown AreaSouthern York CountySusquehanna TownshipUptown YorkWest ShoreYellow BreechesYorkYork-EastYork-North
YES
By Completing this Application, I agree to attend the entire conference from start to finish. If I do not attend or leave early, I will be required to reimburse my sponsoring Rotary Club all or some of the $600 registration fee. By signing, I acknowledge that I have read and agree to this statement. *

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