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Summer Application & Payment Form -> GHL

Payment Information

First Name of Person Paying

Last Name of Person Paying

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Email 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

One time payment of $170.00

2 Players

One time payment of $310.00

3 Players

One time payment of $465.00

4 Players

One time payment of $620.00

Pay with Card (Stripe)

Player 1

Player First Name

Player Last Name

Player Phone/Mobile (optional)

School

Grade

Player Date of Birth

Tell us about any health issues the player has.

Player 2

Player First Name

Player Last Name

Player Phone/Mobile (optional)

School

Grade

Player Date of Birth

Tell us about any health issues the player has.

Player 3

Player First Name

Player Last Name

Player Phone/Mobile (optional)

School

Grade

Player Date of Birth

Tell us about any health issues the player has.

Player 4

Player First Name

Player Last Name

Player Phone/Mobile (optional)

School

Grade

Player Date of Birth

Tell us about any health issues the player has.

Parent/Guardian First Name

Parent/Guardian Email

Parent/Guardian Phone/Mobile

Emergency Contact

Emergency Phone

Waiver for Use of Player Likeness

As 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 Agree

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Payment Information

Player 1

Player 2

Player 3

Player 4

Waiver for Use of Player Likeness

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