This online registration is the "Application Information/Parental Release Form" for "Virtual Junior RYLA for Middle School Studnents."  It requires participant information such as name, nickname, age, sex, mailing address, phone number(s), school, grade, and email address.  It also includes a few declarations.  And, there is a parent/guardian acceptance, plus a "Code of Student" acknowledgment by signarure and/or checkbox.. As this is an electronic online submission form, you have the option to check off the box "AGREED" in lieu of a wet signature.  If you prefer a wet signature, please use the FILLABLE FORM or DOWNLOAD THE APPLICATION; then, save or scan/email the form to youthservices@rotaryd5000.org in order to complete the registration.

For your convenience, please download the application before starting on this online form so that you are able to review, acknowledge, and agree to the "Parent(s)/Guardian(s) Acceptance" and "Code of Student Conduct" declarations.

Please submit this form by October 6, 2023