EMBODl PARTICIPANT REGISTRATION
2023-2024
SECTION 1: PARTICIPANT INFORMATION
Student Name
*
First Name
Last Name
Street Address
*
No P.O. Box
City
*
Zip Code
*
Age (Fall 2023)
*
(in years)
Date of Birth
*
MM/DD/YYYY
School (Fall 2023)
*
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.
SECTION 3: PAYMENT INFORMATION
Click the check box below to pay for your child.
*
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 participant(s) activity fee.
Submit Payment
Should be Empty: