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Girl's Sports Academy

Secure Payment Form
For 5 Week Camp Program

       
Program Cost ($)
Program Date
Girl's Name
Girl's DOB
Girl's School
Girl's Grade
Experience Level
Shirt Size
Friend/Sibling Preference
Updated Physical
Health Issues or Concerns
First Name
Last Name
Phone Number
Email Address
Secondary Parent's Name
Secondary Parent's Phone#
Mailing Address
Mailing Address 2
Mailing City
Mailing State
Mailing Zip
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID