Girl's Sports Academy
Secure Payment Form
For 7 Week Spring Registration
Program Summary
Program Cost ($)
Program Date
Select One
March-May
Girl's Name
Girl's DOB
Girl's School
Girl's Grade
Select One
Grade 2-Grade 5
Grade 6
Experience Level
Select One
Rec Sports only
Advanced Sports Background
Travel Sports Background
Shirt Size
Select One
Youth Small
You Medium
Youth Large
Youth XL
Adult Small
Adult Medium
Friend/Sibling Preference
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#
Credit Card Information
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID
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