{"id":67,"date":"2014-06-04T09:28:14","date_gmt":"2014-06-04T13:28:14","guid":{"rendered":"http:\/\/highimpact.wpengine.com\/girls\/?page_id=67"},"modified":"2016-05-12T12:35:49","modified_gmt":"2016-05-12T16:35:49","slug":"register","status":"publish","type":"page","link":"https:\/\/highimpactlacrosse.com\/girls\/summer-camps\/register\/","title":{"rendered":"Register"},"content":{"rendered":"\n
\n
\n
2016 Summer Camp Registration<\/h3>\n
Register here for the 2016 High Impact Lacrosse Girls Summer Camps. <\/span>\n <\/div>\n
Player Info<\/h2><\/li>
Name
*<\/span><\/label>
\n
\n
\n
First<\/label>\n <\/span>\n
\n
\n
Last<\/label>\n <\/span>\n
<\/div>\n <\/div><\/li>
Gender<\/label>
<\/div><\/li>
Date of Birth
*<\/span><\/label>
\n
\n
Date Format: MM slash DD slash YYYY<\/span>\n <\/div>\n
<\/li>
Grade entering
*<\/span><\/label>
<\/div><\/li>
Position
*<\/span><\/label>
Attack<\/option>
Midfield<\/option>
Defense<\/option>
Goalie<\/option><\/select><\/div><\/li>
High School \/ Youth Program
*<\/span><\/label>
<\/div><\/li>
Parent \/ Guardian Info<\/h2><\/li>
Name
*<\/span><\/label>
\n
\n
\n
First<\/label>\n <\/span>\n
\n
\n
Last<\/label>\n <\/span>\n
<\/div>\n <\/div><\/li>
Email
*<\/span><\/label>
\n
\n
\n
Enter Email<\/label>\n <\/span>\n
\n
\n
Confirm Email<\/label>\n <\/span>\n
<\/div>\n <\/div><\/li>
2nd Email
*<\/span><\/label>
\n
\n
\n
Enter Email<\/label>\n <\/span>\n
\n
\n
Confirm Email<\/label>\n <\/span>\n
<\/div>\n <\/div><\/li>
Address
*<\/span><\/label> \n
\n
\n
\n
Street Address<\/label>\n <\/span>
\n
\n
Address Line 2<\/label>\n <\/span>
\n
\n
City<\/label>\n <\/span>
\n
\n
State \/ Province \/ Region<\/label>\n <\/span>
\n
\n
ZIP \/ Postal Code<\/label>\n <\/span>
\n
<\/option>
Afghanistan<\/option>
Albania<\/option>
Algeria<\/option>
American Samoa<\/option>
Andorra<\/option>
Angola<\/option>
Anguilla<\/option>
Antarctica<\/option>
Antigua and Barbuda<\/option>
Argentina<\/option>
Armenia<\/option>
Aruba<\/option>
Australia<\/option>
Austria<\/option>
Azerbaijan<\/option>
Bahamas<\/option>
Bahrain<\/option>
Bangladesh<\/option>
Barbados<\/option>
Belarus<\/option>
Belgium<\/option>
Belize<\/option>
Benin<\/option>
Bermuda<\/option>
Bhutan<\/option>
Bolivia<\/option>
Bonaire, Sint Eustatius and Saba<\/option>
Bosnia and Herzegovina<\/option>
Botswana<\/option>
Bouvet Island<\/option>
Brazil<\/option>
British Indian Ocean Territory<\/option>
Brunei Darussalam<\/option>
Bulgaria<\/option>
Burkina Faso<\/option>
Burundi<\/option>
Cambodia<\/option>
Cameroon<\/option>
Canada<\/option>
Cape Verde<\/option>
Cayman Islands<\/option>
Central African Republic<\/option>
Chad<\/option>
Chile<\/option>
China<\/option>
Christmas Island<\/option>
Cocos Islands<\/option>
Colombia<\/option>
Comoros<\/option>
Congo, Democratic Republic of the<\/option>
Congo, Republic of the<\/option>
Cook Islands<\/option>
Costa Rica<\/option>
Croatia<\/option>
Cuba<\/option>
Cura\u00e7ao<\/option>
Cyprus<\/option>
Czech Republic<\/option>
C\u00f4te d'Ivoire<\/option>
Denmark<\/option>
Djibouti<\/option>
Dominica<\/option>
Dominican Republic<\/option>
Ecuador<\/option>
Egypt<\/option>
El Salvador<\/option>
Equatorial Guinea<\/option>
Eritrea<\/option>
Estonia<\/option>
Eswatini (Swaziland)<\/option>
Ethiopia<\/option>
Falkland Islands<\/option>
Faroe Islands<\/option>
Fiji<\/option>
Finland<\/option>
France<\/option>
French Guiana<\/option>
French Polynesia<\/option>
French Southern Territories<\/option>
Gabon<\/option>
Gambia<\/option>
Georgia<\/option>
Germany<\/option>
Ghana<\/option>
Gibraltar<\/option>
Greece<\/option>
Greenland<\/option>
Grenada<\/option>
Guadeloupe<\/option>
Guam<\/option>
Guatemala<\/option>
Guernsey<\/option>
Guinea<\/option>
Guinea-Bissau<\/option>
Guyana<\/option>
Haiti<\/option>
Heard and McDonald Islands<\/option>
Holy See<\/option>
Honduras<\/option>
Hong Kong<\/option>
Hungary<\/option>
Iceland<\/option>
India<\/option>
Indonesia<\/option>
Iran<\/option>
Iraq<\/option>
Ireland<\/option>
Isle of Man<\/option>
Israel<\/option>
Italy<\/option>
Jamaica<\/option>
Japan<\/option>
Jersey<\/option>
Jordan<\/option>
Kazakhstan<\/option>
Kenya<\/option>
Kiribati<\/option>
Kuwait<\/option>
Kyrgyzstan<\/option>
Lao People's Democratic Republic<\/option>
Latvia<\/option>
Lebanon<\/option>
Lesotho<\/option>
Liberia<\/option>
Libya<\/option>
Liechtenstein<\/option>
Lithuania<\/option>
Luxembourg<\/option>
Macau<\/option>
Macedonia<\/option>
Madagascar<\/option>
Malawi<\/option>
Malaysia<\/option>
Maldives<\/option>
Mali<\/option>
Malta<\/option>
Marshall Islands<\/option>
Martinique<\/option>
Mauritania<\/option>
Mauritius<\/option>
Mayotte<\/option>
Mexico<\/option>
Micronesia<\/option>
Moldova<\/option>
Monaco<\/option>
Mongolia<\/option>
Montenegro<\/option>
Montserrat<\/option>
Morocco<\/option>
Mozambique<\/option>
Myanmar<\/option>
Namibia<\/option>
Nauru<\/option>
Nepal<\/option>
Netherlands<\/option>
New Caledonia<\/option>
New Zealand<\/option>
Nicaragua<\/option>
Niger<\/option>
Nigeria<\/option>
Niue<\/option>
Norfolk Island<\/option>
North Korea<\/option>
Northern Mariana Islands<\/option>
Norway<\/option>
Oman<\/option>
Pakistan<\/option>
Palau<\/option>
Palestine, State of<\/option>
Panama<\/option>
Papua New Guinea<\/option>
Paraguay<\/option>
Peru<\/option>
Philippines<\/option>
Pitcairn<\/option>
Poland<\/option>
Portugal<\/option>
Puerto Rico<\/option>
Qatar<\/option>
Romania<\/option>
Russia<\/option>
Rwanda<\/option>
R\u00e9union<\/option>
Saint Barth\u00e9lemy<\/option>
Saint Helena<\/option>
Saint Kitts and Nevis<\/option>
Saint Lucia<\/option>
Saint Martin<\/option>
Saint Pierre and Miquelon<\/option>
Saint Vincent and the Grenadines<\/option>
Samoa<\/option>
San Marino<\/option>
Sao Tome and Principe<\/option>
Saudi Arabia<\/option>
Senegal<\/option>
Serbia<\/option>
Seychelles<\/option>
Sierra Leone<\/option>
Singapore<\/option>
Sint Maarten<\/option>
Slovakia<\/option>
Slovenia<\/option>
Solomon Islands<\/option>
Somalia<\/option>
South Africa<\/option>
South Georgia<\/option>
South Korea<\/option>
South Sudan<\/option>
Spain<\/option>
Sri Lanka<\/option>
Sudan<\/option>
Suriname<\/option>
Svalbard and Jan Mayen Islands<\/option>
Sweden<\/option>
Switzerland<\/option>
Syria<\/option>
Taiwan<\/option>
Tajikistan<\/option>
Tanzania<\/option>
Thailand<\/option>
Timor-Leste<\/option>
Togo<\/option>
Tokelau<\/option>
Tonga<\/option>
Trinidad and Tobago<\/option>
Tunisia<\/option>
Turkey<\/option>
Turkmenistan<\/option>
Turks and Caicos Islands<\/option>
Tuvalu<\/option>
US Minor Outlying Islands<\/option>
Uganda<\/option>
Ukraine<\/option>
United Arab Emirates<\/option>
United Kingdom<\/option>
United States<\/option>
Uruguay<\/option>
Uzbekistan<\/option>
Vanuatu<\/option>
Venezuela<\/option>
Vietnam<\/option>
Virgin Islands, British<\/option>
Virgin Islands, U.S.<\/option>
Wallis and Futuna<\/option>
Western Sahara<\/option>
Yemen<\/option>
Zambia<\/option>
Zimbabwe<\/option>
\u00c5land Islands<\/option><\/select>\n
Country<\/label>\n <\/span>\n
<\/div>\n <\/div><\/li>
Phone
*<\/span><\/label>
<\/div><\/li>
Emergency Contact #
*<\/span><\/label>
<\/div><\/li>
<\/label>
<\/textarea><\/div><\/li><li id='field_10_21' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' >WAIVER RELEASE: My child is in good health and has my full permission to participate in a vigorous lacrosse program. My child has no previous sickness, illness, disease or bodily injury that is contradictory to participation. I fully understand that lacrosse is a contact sport and that physical injury may occur during the course of practice and games. In the event that I cannot be reached I give my full permission for such medical procedures as may be deemed necessary by an examining physician. I also understand that Hi-Impact Lacrosse, Inc. is not responsible for the loss of any personal items.<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_10_21'><li class='gchoice_10_21_1'>\n\t\t\t\t\t\t\t\t<input name='input_21.1' type='checkbox' value='I agree' id='choice_10_21_1' \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_21_1' id='label_10_21_1'>I agree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id='field_10_16' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>Camp Information<\/h2><\/li><li id='field_10_17' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_10_17' >Camp<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_10_17' class='medium gfield_select' aria-required=\"true\" aria-invalid=\"false\"><option value='Week 1: June 27th - June 30th' >Week 1: June 27th - June 30th<\/option><option value='Week 2: July 5th - July 8th' >Week 2: July 5th - July 8th<\/option><option value='Both weeks' >Both weeks<\/option><\/select><\/div><\/li><li id='field_10_18' class='gfield gfield_price gfield_price_10_18 gfield_product_10_18 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' >Registration Type<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_18'><li class='gchoice_10_18_0'><input name='input_18' type='radio' value='Full Day ($305)|305' id='choice_10_18_0' \/><label for='choice_10_18_0' id='label_10_18_0'>Full Day ($305)<\/label><\/li><li class='gchoice_10_18_1'><input name='input_18' type='radio' value='PeeWees ($140)|140' id='choice_10_18_1' \/><label for='choice_10_18_1' id='label_10_18_1'>PeeWees ($140)<\/label><\/li><li class='gchoice_10_18_2'><input name='input_18' type='radio' value='Both weeks ($610)|610' id='choice_10_18_2' \/><label for='choice_10_18_2' id='label_10_18_2'>Both weeks ($610)<\/label><\/li><\/ul><\/div><\/li><li id='field_10_19' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' >Payment Type<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_10_19'><li class='gchoice_10_19_0'><input name='input_19' type='radio' value='Check' id='choice_10_19_0' \/><label for='choice_10_19_0' id='label_10_19_0'>Check<\/label><\/li><li class='gchoice_10_19_1'><input name='input_19' type='radio' value='Credit Card' id='choice_10_19_1' \/><label for='choice_10_19_1' id='label_10_19_1'>Credit Card (3% Convenience Fee)<\/label><\/li><\/ul><\/div><\/li><li id='field_10_28' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_10_28' >Coupon Code<\/label><div class='ginput_container' id='gf_coupons_container_10'><input id='gf_coupon_code_10' class='gf_coupon_code' onkeyup='DisableApplyButton(10);' onchange='DisableApplyButton(10);' type='text' \/><input type='button' disabled='true' onclick='ApplyCouponCode(10);' value='Apply' id='gf_coupon_button' class='button' \/> <img style='display:none;' id='gf_coupon_spinner' src='https:\/\/highimpactlacrosse.com\/girls\/wp-content\/plugins\/gravityformscoupons\/images\/spinner.gif' alt='please wait'\/><div id='gf_coupon_info'><\/div><input type='hidden' id='gf_coupon_codes_10' name='input_28' value='' \/><input type='hidden' id='gf_total_no_discount_10'\/><input type='hidden' id='gf_coupons_10' name='gf_coupons_10' value='' \/><\/div><\/li><li id='field_10_22' class='gfield gfield_price gfield_price_10_22 gfield_product_10_22 gfield_contains_required gfield_calculation field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_10_22_1' >Product Name<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_22.1' value='Product Name' class='gform_hidden' \/>\n\t\t\t\t\t<span class='ginput_product_price_label'>Price:<\/span> <span class='ginput_product_price' id='input_10_22'>$0.00<\/span>\n\t\t\t\t\t<input type='hidden' name='input_22.2' id='ginput_base_price_10_22' class='gform_hidden' value='$0.00'\/>\n\t\t\t\t\t<input type='hidden' name='input_22.3' value='1' class='ginput_quantity_10_22 gform_hidden' \/>\n\t\t\t\t<\/div><\/li><li id='field_10_23' class='gfield gfield_price gfield_price_10_ gfield_total gfield_total_10_ field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_10_23' >Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t<span class='ginput_total ginput_total_10' aria-live='polite'>$0.00<\/span>\n\t\t\t\t\t\t<input type='hidden' name='input_23' id='input_10_23' class='gform_hidden'\/>\n\t\t\t\t\t<\/div><\/li><li id='field_10_29' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_10_29' >CAPTCHA<\/label><div id='input_10_29' class='ginput_container ginput_recaptcha' data-sitekey='6Lcq9fIUAAAAACUtVPdU659rk2HvdQhJz8AjGq0U' data-theme='light' data-tabindex='0' data-badge=''><\/div><\/li><li id='field_10_24' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' >Please make check payable to High Impact Lacrosse Inc.\n<br \/> <br\/>Mail To:<br\/>\n\nHigh Impact Lacrosse Inc.<br\/>\nP.O. Box 1214<br\/>\nYonkers, NY 10703<\/li><li id='field_10_25' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>Billing Info<\/h2><\/li><li id='field_10_26' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_10_26_1' >Credit Card<span class='gfield_required'>*<\/span><\/label><div class='ginput_complex ginput_container ginput_container_creditcard' id='input_10_26'><span class='ginput_full' id='input_10_26_1_container' >\n <div class='gform_card_icon_container gform_card_icon_style1'><div class='gform_card_icon gform_card_icon_amex' >American Express<\/div><div class='gform_card_icon gform_card_icon_discover' >Discover<\/div><div class='gform_card_icon gform_card_icon_mastercard' >MasterCard<\/div><div class='gform_card_icon gform_card_icon_visa' >Visa<\/div><\/div>\n <input type='text' id='input_10_26_1' value='' onchange='gformMatchCard(\"input_10_26_1\");' onkeyup='gformMatchCard(\"input_10_26_1\");' \/>\n <label for='input_10_26_1' id='input_10_26_1_label' >Card Number<\/label>\n <\/span><span class='ginput_full ginput_cardextras' id='input_10_26_2_container'>\n <span class='ginput_cardinfo_left' id='input_10_26_2_cardinfo_left'>\n <span class='ginput_card_expiration_container ginput_card_field'>\n <select name='input_26.2[]' id='input_10_26_2_month' class='ginput_card_expiration ginput_card_expiration_month'>\n <option value=''>Month<\/option><option value='1' >01<\/option><option value='2' >02<\/option><option value='3' >03<\/option><option value='4' >04<\/option><option value='5' >05<\/option><option value='6' >06<\/option><option value='7' >07<\/option><option value='8' >08<\/option><option value='9' >09<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option>\n <\/select>\n <select name='input_26.2[]' id='input_10_26_2_year' class='ginput_card_expiration ginput_card_expiration_year'>\n <option value=''>Year<\/option><option value='2026' >2026<\/option><option value='2027' >2027<\/option><option value='2028' >2028<\/option><option value='2029' >2029<\/option><option value='2030' >2030<\/option><option value='2031' >2031<\/option><option value='2032' >2032<\/option><option value='2033' >2033<\/option><option value='2034' >2034<\/option><option value='2035' >2035<\/option><option value='2036' >2036<\/option><option value='2037' >2037<\/option><option value='2038' >2038<\/option><option value='2039' >2039<\/option><option value='2040' >2040<\/option><option value='2041' >2041<\/option><option value='2042' >2042<\/option><option value='2043' >2043<\/option><option value='2044' >2044<\/option><option value='2045' >2045<\/option>\n <\/select>\n <label for='input_10_26_2_month' >Expiration Date<\/label>\n <\/span>\n <\/span><span class='ginput_cardinfo_right' id='input_10_26_2_cardinfo_right'>\n <input type='text' id='input_10_26_3' class='ginput_card_security_code' value='' \/>\n <span class='ginput_card_security_code_icon'> <\/span>\n <label for='input_10_26_3' >Security Code<\/label>\n <\/span>\n <\/span><span class='ginput_full' id='input_10_26_5_container'>\n <input type='text' id='input_10_26_5' value='' \/>\n <label for='input_10_26_5' id='input_10_26_5_label' >Cardholder Name<\/label>\n <\/span> <\/div><\/li>\n <\/ul><\/div>\n <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_10' class='gform_button button' value='Submit' onclick='if(window[\"gf_submitting_10\"]){return false;} window[\"gf_submitting_10\"]=true; 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