{"id":577,"date":"2025-07-18T03:03:26","date_gmt":"2025-07-18T03:03:26","guid":{"rendered":"https:\/\/eleader.org\/?page_id=577"},"modified":"2025-07-18T03:10:04","modified_gmt":"2025-07-18T03:10:04","slug":"payment-2","status":"publish","type":"page","link":"https:\/\/eleader.org\/?page_id=577","title":{"rendered":"Girl Scout Cookie CEO Academy Registration"},"content":{"rendered":"\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-576 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-576\" data-uid=\"6a65ed17dea5e\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-576\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-576 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"576\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a65ed17dea5e\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a65ed17dea5e\" id=\"forminator-field-name-1_6a65ed17dea5e-label\" class=\"forminator-label\">Participant&#039;s Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-1_6a65ed17dea5e\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-576__field--select-2_6a65ed17dea5e\" id=\"forminator-form-576__field--select-2_6a65ed17dea5e-label\" class=\"forminator-label\">Grade<\/label><select  id=\"forminator-form-576__field--select-2_6a65ed17dea5e\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-576__field--select-2_6a65ed17dea5e-label\"><option value=\"one\"  data-calculation=\"0\">4th Grade<\/option><option value=\"two\"  data-calculation=\"0\">5th Grade<\/option><option value=\"8th-Grade\"  data-calculation=\"0\">6th Grade<\/option><option value=\"7th-Grade\"  data-calculation=\"0\">7th Grade<\/option><option value=\"8th-Grade\"  data-calculation=\"0\">8th Grade<\/option><option value=\"High-School\"  data-calculation=\"0\">High School<\/option><option value=\"Other\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a65ed17dea5e\" id=\"forminator-field-name-2_6a65ed17dea5e-label\" class=\"forminator-label\">Guardian Name(s)<\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-2_6a65ed17dea5e\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a65ed17dea5e\" id=\"forminator-field-phone-1_6a65ed17dea5e-label\" class=\"forminator-label\">Guardian Phone Number<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. +1 300 400 5000\" id=\"forminator-field-phone-1_6a65ed17dea5e\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a65ed17dea5e\" id=\"forminator-field-email-1_6a65ed17dea5e-label\" class=\"forminator-label\">Guardian Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_6a65ed17dea5e\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a65ed17dea5e\" id=\"forminator-field-address-1-street_address_6a65ed17dea5e-label\" class=\"forminator-label\">Street Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-1-street_address_6a65ed17dea5e\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1-address_line\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-address_line_6a65ed17dea5e\" id=\"forminator-field-address-1-address_line_6a65ed17dea5e-label\" class=\"forminator-label\">Apartment, suite, etc<\/label><input type=\"text\" name=\"address-1-address_line\" placeholder=\"\" id=\"forminator-field-address-1-address_line_6a65ed17dea5e\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_6a65ed17dea5e\" id=\"forminator-field-address-1-city_6a65ed17dea5e-label\" class=\"forminator-label\">City <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"E.g. Sydney\" id=\"forminator-field-address-1-city_6a65ed17dea5e\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><div id=\"address-1-state\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-state_6a65ed17dea5e\" id=\"forminator-field-address-1-state_6a65ed17dea5e-label\" class=\"forminator-label\">State\/Province <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-state\" placeholder=\"E.g. New South Wales\" id=\"forminator-field-address-1-state_6a65ed17dea5e\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_6a65ed17dea5e\" id=\"forminator-field-address-1-zip_6a65ed17dea5e-label\" class=\"forminator-label\">ZIP \/ Postal Code <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"E.g. 2000\" id=\"forminator-field-address-1-zip_6a65ed17dea5e\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_6a65ed17dea5e\" id=\"forminator-field-name-3_6a65ed17dea5e-label\" class=\"forminator-label\">Emergency Contact<\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-3_6a65ed17dea5e\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_6a65ed17dea5e\" id=\"forminator-field-phone-2_6a65ed17dea5e-label\" class=\"forminator-label\">Emergency Contact Phone Number<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"E.g. +1 300 400 5000\" id=\"forminator-field-phone-2_6a65ed17dea5e\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a65ed17dea5e\" id=\"forminator-field-text-2_6a65ed17dea5e-label\" class=\"forminator-label\">Allergies or Pertinent Medical Information<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"E.g. food allergies\" id=\"forminator-field-text-2_6a65ed17dea5e\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6a65ed17dea5e\" id=\"forminator-field-consent-1_6a65ed17dea5e-label\" class=\"forminator-label\">Consent <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_6a65ed17dea5e__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6a65ed17dea5e\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6a65ed17dea5e-label\" aria-describedby=\"forminator-field-consent-1_6a65ed17dea5e__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6a65ed17dea5e__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>I, the undersigned, hereby agree to the following terms and conditions for participating in &#8220;Cookie CEO Academy.&#8221; Please read thoroughly.&nbsp;<\/p>\n<p><strong>1. Acknowledgment of Risks:<\/strong><\/p>\n<p>I understand that participation in the event involves certain inherent risks and activities. I acknowledge and voluntarily assume all such risks, including but not limited to injuries, accidents, and other potential hazards.<\/p>\n<p><strong>2. Consent for Photography and Publicity:<\/strong><\/p>\n<p>I grant permission to The Elite Leadership Summit, Inc to photograph, film, or record my likeness and voice during this event.&nbsp; I understand that these images and recordings may be used for promotional or publicity purposes, including but not limited to newsletters, websites, social media, and other promotional materials.&nbsp;<\/p>\n<p><strong>3. Waiver of Liability:<\/strong><\/p>\n<p>I hereby release and discharge The Elite Leadership Summit, Inc, its officers, directors, employees, volunteers, and all other persons or entities acting under its authority, from any and all claims, liabilities, demands, actions, or causes of action whatsoever, arising out of or related to any loss, damage, or injury that may occur during my participation in \u201cCookie CEO Academy.&#8221;<\/p>\n<p><strong>4. Assumption of Responsibility:<\/strong><\/p>\n<p>I understand and agree that I am responsible for my own well-being during the event. I agree to&nbsp;<strong>comply with all rules and instructions<\/strong>&nbsp;provided by event organizers.<\/p>\n<p><strong>5. Emergency Medical Treatment Authorization:<\/strong><\/p>\n<p>In the event of a medical emergency, I authorize The Elite Leadership Summit, Inc and its representatives to obtain medical treatment on my behalf. I understand that efforts will be made to contact me or my emergency contact before such action is taken.<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"stripe-ocs-1\" class=\"forminator-field-stripe-ocs forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"stripe-ocs-1-field\" id=\"stripe-ocs-1-field-label\" class=\"forminator-label\">Credit \/ Debit Card <span class=\"forminator-required\">*<\/span><\/label><div id=\"payment-element-6a65ed17dea5e\" data-elements-options=\"{\n    &quot;loader&quot;: &quot;always&quot;,\n    &quot;locale&quot;: &quot;auto&quot;,\n    &quot;paymentMethodCreation&quot;: &quot;manual&quot;,\n    &quot;fonts&quot;: [\n        {\n            &quot;family&quot;: &quot;Roboto&quot;,\n            &quot;cssSrc&quot;: &quot;https:\\\/\\\/fonts.bunny.net\\\/css?family=Roboto&quot;\n        }\n    ],\n    &quot;appearance&quot;: {\n        &quot;theme&quot;: &quot;stripe&quot;,\n        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