ESB Academy Waiver and CC Authorization Form

ESB Academy 2022-2023 Info/Waiver

Step 1 of 2

ESB Academy Client Info and Waiver

Players Name(Required)

First Last

DOB(Required)

Players Cell Phone(Required)

Players Email(Required)

Shirt Size(Required)

Short Size(Required)

Preferred Number: (Pick 3 options)(Required)

Emergency Contact

Name(Required)

First Last

Phone(Required)

Relationship to Player?(Required)

Parent Guardian Information

Guardian 1(Required)

First Last

Phone(Required)

Email(Required)

Guardian 2

First Last

Phone

Electronic Signature(Required)

First Last

Date

Credit Card Authorization (Tuition)

Credit Card Recurring Payment Authorization Form / Cancellation Policy – Elite Squad Baseball LLC How Recurring Payments Work: You authorize Elite Squad Baseball LLC to charge your Visa, MasterCard, American Express or Discover card on the 1st of every month for your monthly dues for your tuition.

Billing Information

Credit Card(Required)

Name on Card(Required)

First Last

Account Number(Required)

Expiration Date(Required)

CVV(Required)

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Electronic Signature

First Last

Date