Summer Application & Payment Form -> GHLPayment InformationFirst Name of Person PayingLast Name of Person PayingBilling AddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweEmail Address of Person PayingPhone/Mobile of Person PayingWho paid for the Session or Camp for this player?How many Players are you registering?1 PlayerOne time payment of $170.002 PlayersOne time payment of $310.003 PlayersOne time payment of $465.004 PlayersOne time payment of $620.00Pay with Card (Stripe)Player 1Player First NamePlayer Last NamePlayer Phone/Mobile (optional)SchoolGrade- Select -Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Player Date of BirthTell us about any health issues the player has. Player 2Player First NamePlayer Last NamePlayer Phone/Mobile (optional)SchoolGrade- Select -Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Player Date of BirthTell us about any health issues the player has. Player 3Player First NamePlayer Last NamePlayer Phone/Mobile (optional)SchoolGrade- Select -Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Player Date of BirthTell us about any health issues the player has. Player 4Player First NamePlayer Last NamePlayer Phone/Mobile (optional)SchoolGrade- Select -Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Player Date of BirthTell us about any health issues the player has. Parent/Guardian First NameParent/Guardian First NameParent/Guardian EmailParent/Guardian Phone/MobileEmergency ContactEmergency PhoneWaiver for Use of Player LikenessAs parent or guardian of the player on this application, I hereby grant permission to the rights of his/her image or likeness as recorded on video or in photographs without payment or any other consideration. By signing this release I understand this permission signifies that photographic or video recordings of this player may be electronically displayed via the Internet or in the public educational setting.I agree to the Likeness Waiver I AgreeSubmit Form