Empowerment Academy 2022 Leadership Awards Application
Name
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First Name
Last Name
Age
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Date of birth
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Mailing address
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City
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State
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Zip code
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Email
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Phone
Registration Fee
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I will pay the $79 registration fee via PayPal Friends and Family to info@darcycastro.com
I will pay the $79 registration fee via Venmo @Darcy-Castro
Please describe any accommodations you may need:
List three things about you. Can be interests, facts or accomplishments.
If you were referred to the program, please list their name here:
Name of parent or legal guardian (if under the age of 18)
Agreement for Participation
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I have read the Contestant Handbook & Agreement for Participation, and agree to abide by the rules as set forth by the Empowerment Academy.
Signature
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Submit
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