Girl's Sports Academy
Secure Payment Form
For 5 Day Camp Program
Program Summary
Program Cost ($)
Program Date
Select One
June 26th - June 30th
Girl's Name
Girl's DOB
Girl's School
Girl's Grade
Select One
Grade 2-4 Beginner GSA
Grade 2-4 Advanced GSA
Grade 5-7 Beginner GSA
Grade 5-7 Advanced GSA
Experience Level
Select One
GSA Previous Experience
Never played organized sports
Rec Sports Experience
Travel Sports Experience
Shirt Size
Select One
Youth Small
Youth Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Updated Physical
Select One
YES
NO
Health Issues or Concerns
Primary Parent or Guardian Information
First Name
Last Name
Phone Number
Email Address
Secondary Parent's Name
Secondary Parent's Phone#
Mailing Information
Mailing Address
Mailing Address 2
Mailing City
Mailing State
Mailing Zip
Credit Card Information
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
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