CLUB WAIVER RELEASE
CLUB WAIVER RELEASE
AUTO DEBIT FORM - DAY CAMP SUMMER 2017
Optional Auto-Debit Credit Card Authorization Form Summer 2018
Please complete one form per household.
PARENT OR GUARDIAN NAME
AVOID LATE FEES! PROVIDE CREDIT CARD INFORMATION OR PRINT THE FORM BELOW AND EMAIL OR BRING IT TO CADENCE AT LEAST ONE WEEK PRIOR TO THE FIRST DAY OF CAMP:
Schedule your payment to be automatically deducted from your Visa, MasterCard, American Express or Discover Card. Just complete and sign this form to get started!
The CSFC Day Summer Camp requires WEEKLY recurring payments.
Here’s How Recurring Payments Work:
You authorize regularly scheduled charges to your credit card. You will be charged the amount indicated below each billing period the Friday prior to each camp week. A receipt for each payment will be emailed to you and the charge will appear on your bank statement as an “ACH Debit.” You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.
Please complete the information below:
I authorize Cadence Soccer Mgmt., LLC to charge my credit card indicated below in the amount of my corresponding weekly fee plus+ $3 convenience fee per child on each Monday one week prior to the camp schedule. I understand that my payment commitment to Cadence Soccer Mgmt., LLC is weekly until the last week of this Summer Day Camp program as indicated in Cadence's advertising materials . I understand that any unpaid balance due to a declined transaction may interrupt my child/children's activities with Cadence Soccer & Futsal Club, LLC.
CREDIT CARD COMPANY
CREDIT CARD NUMBER
3 DIGIT CODE (4 IF AMEX)
I understand that this authorization will remain in effect until the end of summer day camp season, and I agree to notify Cadence Soccer Mgmt., LLC in writing of any changes in my account information or termination of this authorization at least 15 days prior to the soccer league season. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that Cadence Soccer Mgmt., LLC may at its discretion attempt to process the charge again within 10 days, and agree to an additional $35 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card companies; so long as the transactions correspond to the terms indicated in this authorization form.
RECURRING AUTHORIZATION FORM
CSFC is committed to providing our community a safe, fun and well organized place to play Futsal.
2250 South Chicago St. - Joliet, IL 60436
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