FAC Junior Run Club Registration – Fayetteville Athletic Club

Child's Name*

First Last

Birth Date*

Child's Age*

Select Months Attending*

November 2025

December 2025

January 2026

February 2026

March 2026

April 2026

May 2026

June 2026

July 2026

Injuries/Medical Conditions?

Other Conditions or Comments?

Primary Parent/ Caregiver Name*

First Last

Primary Parent/ Guardian Cell Phone*

Home Address*

Street Address City State ZIP Code

Primary Caregiver Email*

Secondary Parent/Caregiver Name

First Last

Secondary Caregiver Cell Phone

Home Address

Street Address Address Line 2 State ZIP Code

Secondary Caregiver Email

Credit Card Number*

Credit Card Type*

Expiration Date*

CVV*

Name on Credit Card*

First Last