EMBODl PARTICIPANT REGISTRATION
2024-2025
SECTION 1: PARTICIPANT INFORMATION
Student Name:
*
First Name
Last Name
Street Address:
*
No P.O. Box
City:
*
Zip Code:
*
Age (Fall 2024):
*
(in years)
Date of Birth:
*
MM/DD/YYYY
School (Fall 2024):
*
School City/County:
*
Allergies (If none, write N/A):
Favorite Hobbies or Interests:
SECTION 2: PARENT INFORMATION
Parent Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Parent's Email Address:
*
Please include PERSONAL email address only. Work email addresses not allowed.
Emergency Contact:
*
First Name
Last Name
Emergency Contact Phone Number:
*
Please enter a valid phone number.
SECTION 3: PAYMENT INFORMATION
Click the check box below to pay for your child.
*
2024 Participant Fee (Non-Refundable) $25.00
SECTION 4: PAYMENT
Total Amount (USD)
Final Payment Amount:
*
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( X )
USD
This is the amount that you are agreeing to submit to FAAC for your 2024-2025 participant(s) activity fee.
Submit Payment
Should be Empty: