2022-2023 EMBODI Participant Registration Form

Online Registration for the 2022-2023 Academic Year is now closed. However, you may complete the application to be waitlisted for next year. Thank you for your interest in EMBODI.
Participant Registration Form

($25 Non-Refundable Activity Fee to be submitted during EMBODI orientation.)
STUDENT'S INFORMATION
Student's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address
This will be used to provide program information/updates.
Age
Date of Birth

MonthDayYear
Date
School
School City/County
Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-LargeAdult 2X-Large
Favorite Celebrity or Role Model
Favorite Hobbies or Interests
PARENT/GUARDIAN INFORMATION
Parent/Guardian's Name

First NameLast Name
Email Address
This will be used to provide program information/updates.
Should be Empty: