Payment InformationFirst Name of Person Paying Last Name of Person Paying Billing AddressAddress Line 1 Address Line 2 City State Zip Code Country Select 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 Paying Phone/Mobile of Person Paying Who paid for the Session or Camp for this player? How many Players are you registering? 1 Player$170.00 for each month, for 5 installments2 Players$310.00 for each month, for 5 installments3 Players$465.00 for each month, for 5 installments4 Players$620.00 for each month, for 5 installmentsPay with Card (Stripe)Player 1Player First Name Player Last Name Player Phone/Mobile (optional) School Grade - Select -Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Player Date of Birth Tell us about any health issues the player has. Player 2Player First Name Player Last Name Player Phone/Mobile (optional) School Grade - Select -Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Player Date of Birth Tell us about any health issues the player has. Player 3Player First Name Player Last Name Player Phone/Mobile (optional) School Grade - Select -Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Player Date of Birth Tell us about any health issues the player has. Player 4Player First Name Player Last Name Player Phone/Mobile (optional) School Grade - Select -Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Player Date of Birth Tell us about any health issues the player has. Parent/Guardian First Name Parent/Guardian First Name Parent/Guardian Email Parent/Guardian Phone/Mobile Emergency Contact Emergency Phone Waiver 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
