Parent/Guardian name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child #1 *

First Name

Last Name

DOB *

MM

DD

YYYY

BILLING AGREEMENT *

This agreement is between the customer and CRUZEIRO EC Soccer Academy in relation to business. Monthly payments will be processed on the 15th of every month. Any account past due will incur in a late processing fee of $30. CRUZEIRO EC Soccer Academy is not responsible for any credit card fees incurred by the customer. CRUZEIRO EC Soccer Academy has the sole right to modify any payment due date and to resubmit returned or declined items without prior notice. By checking this box you authorize CRUZEIRO EC Soccer Academy Inc to charge all fees expressly stated on the signed agreement including Uniform, initial deposit and monthly payment. Please let us know if you have any questions.

AGREE

LATE FEE

The monthly fee is $199 a month and will be charged in the card on file on the 15th of every month. You can cancel this agreement at anytime, by sending us written communication at least 10 days prior to the next due date. PLEASE NOTE DATE IF YOUR PAYMENT METHOD FAILS AT THE DUE DATE WE WILL CHARGE A $30 LATE PROCESSING FEE.

AGREE

CANCELATION: *

Your membership may cancelled at any time, but it must be made within 15 days prior to the next billing period in order to have effect on the next monthly charge. If you choose to cancel the service after your card has been billed for the month or year, there will be no refund. Your membership will continue to be active until the end of your current billing cycle. Your membership will not renew following the end of your current billing cycle.

AGREE

Release and Liability Waiver

I release CRUZEIRO, it’s owners, instructors, employees, agents and servants, from any and all liability for personal injury to me and/or my child, or ward, as the result of any negligence arising out of or in the course of or in any way related to my or my child’s use of the facilities, equipment, apparatus or premises of CRUZEIRO and/or my or my child’s participation in any class, program, competition or other event organized, run and/or sponsored by CRUZEIRO, whether at it’s facilities or elsewhere, on behalf of myself and my child and/or ward, I agree to indemnify and hold harmless the said CRUZEIRO and its owners, operators, instructors, employees, agents and servants from any and all claims, damages, demands, costs, expenses and compensation arising out of or in the course of or in any way related to any personal injury to me or my child. Medical Authorization: I fully understand that CRUZEIROs staff, owners and representatives are not physicians or medical practitioners of any kind. With the above in mind, I hereby grant consent and permission to CRUZEIROs staff, owners and representatives to render temporary first aid to my child in the event of any injury or illness, and if deemed necessary by the CRUZEIRO staff to call a doctor and seek medical help, including transportation to any health care facility or hospital for said child, should the staff deem this necessary. Acknowledgement of Activity Risks: I acknowledge my understanding and acceptance of the following: The activities offered by CRUZEIRO include active sports, which can result in injury to participants and/or spectators. In my absence CRUZEIRO does not assume any responsibility for the care, custody, control, condition, health or well being of my child and/or ward. I acknowledge that CRUZEIRO has rules and policies in place regarding safety, use of facilities, conduct and the like. The rules in CRUZEIROs discretion may result in revocation of all privileges provided by CRUZEIRO without refund or any prepaid fees. By signing below, I certify that I have read and agree with the above authorizations, releases and acknowledgements.

AGREE

Use of Images/Name Identification: *

I authorize CRUZEIRO to use images in print and on the internet of me or my child, or ward, both with or without name identification for CRUZEIRO publicity, promotional & advertising purposes, and release any and all claims and/or rights I or my child might have as a result.

AGREE

By selecting this box, I acknowledge that I have read, understood and agre with the MA Parent's, Guardians and Spectators Code of Conduct Provided on the link below. *

https://mayouthsoccer.org/wp-content/uploads/2023/12/mass_youth_soccer_parents_code_of_conduct_jan_23.pdf

Agree

By clicking on the box and typing my name, I acknowledge that I have read, understand, and agree to all the polices above, including the Cancellation, Late Fee and Refund policies as defined above. *

AGREE

Parent/Guardian Signature *

First Name

Last Name