FAC Junior Run Club Registration Junior Run Club Registration "*" indicates required fields Step 1 of 4 – Child Information 25% Child Basic InformationChild's Name* First Last Birth Date* MM slash DD slash YYYY Child's Age*Select Months Attending*FAC Members: $65/month; FAC Guests: $75/month June 2025 (Tuesdays; 4:30pm – 5:15pm) July 2025 (Tuesdays; 4:30pm – 5:15pm) Select AllInjuries/Medical Conditions?Other Conditions or Comments? Primary Parent/Guardian InformationPrimary Parent/ Caregiver Name* First Last Primary Parent/ Guardian Cell Phone*Home Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Caregiver Email* Secondary Parent/Caregiver InformationSecondary Parent/Caregiver Name First Last Secondary Caregiver Cell PhoneHome Address Street Address Address Line 2 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Secondary Caregiver Email Billing InformationCredit Card Number*Credit Card Type*VISAMastercardDiscoverAmerican ExpressExpiration Date* CVV* Name on Credit Card* First Last Agreements*All Junior Run Club participants must have a Junior FAC membership to receive the member rate. Junior Run Club Dues must be received on or before the 5th of the month for participation in the same month. Dues may be paid by check, cash, credit card or may be conveniently added to your monthly membership draft if automatic payment is preferred. If auto payment is selected, cancellation must be received in writing on or before the 20th of the month to avoid billing on the first of the following month. If payment is not received on or before the 5th and participation in program is actively occurring, the FAC reserves the right to charge credit card on file for monthly program balance due. I understand and agree to the above policies.
