RYLA 2025 District Committee:
Holly Hanson, Crossville - Chair
Paul Beal, Crossville - Treasurer
Emily Rice, Oak Ridge - Registration Coordinator
Deb Birdsall, Fairfield Glade - Website and Social Media
Charlotte Goodwin, Crossville - Certificate Coordinator
Pepe Perron, Crossville - Advisor
Student Registration Form
Rotary International District 6780
RYLA (Rotary Youth Leadership Awards) Registration
Saturday, September 26, 2026
Sign-in/Breakfast 7:00 a.m. - 8:00 a.m. (Central Time)
Event from 8:10 a.m. - 5:00 p.m. (Central Time)(must stay through closing event)
PLEASE PRINT CLEARLY! Complete ALL areas LEGIBLY!
Use the back for additional space if needed.
Name
First Name
Last Name
Name you normally go by:
Student Cell #:
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Special Diet Needs?
Please provide emergency contact information:
Emergency Contact:
Relationship:
Mobile Phone:
Format: (000) 000-0000.
Important! SPONSORING ROTARY CLUB:
HIGH SCHOOL:
What leadership positions have you held? (Clubs, offices, sports, church activities, etc.) Use back of page as needed.
1.
2.
3.
STOP → Please review the above information for COMPLETENESS and LEGIBILITY!!!
Promptly email this form, along with the signed RYLA Waiver, Rules and Guidelines and Adventureworks Release of Liability Forms (4 forms) to your Local Rotary Club RYLA Coordinator:
CLUB'S RYLA Coordinator Name:
Cell#(
Format: (000) 000-0000.
Email:
example@example.com
Rotarian driver name:
Mobile Phone #
Format: (000) 000-0000.
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