BOSTON AMERICANS ONLINE PAYMENT FORM
All Fields marked with an asterisk (*) are required.

Player Information   Payment Information
Team:*
First Name:*
Last Name:*
Street:*
Apt:
City:*
State:*
Zip Code:*
Phone (Evening):*  ( – 
Phone (Daytime):*  ( – 
Email:*
 
Payment Amount: $
Using your 2018-19 Annual Tuition Payment Schedule as a guide, please input the amount that you would like to pay at this time. You have the option of paying electronically in two ways: 1) one in-full, manual payment; or 2) monthly manual payments. If you would like to set up automatic monthly recurring payments, please contact Colleen Amedure via phone (978-557-5518) or email (camedure@valley-associates.com).

Credit Card Type: *
Name on Card: *
Billing Address same as Player's Address
Billing Street:*
Billing Apt:
Billing City:*
Billing State:*
Billing Zip Code:*
Card Number: *
Enter numbers only, no spaces or dashes
Expiry Date *   
Waiver
I/we understand that accident, health and personal insurance are not provided. I/we verify the above information to be true and give our child permission to participate in the Boston Americans Program. I/we the parents/guardians of the above named registrant in the Boston Americans Program, hereby give permission for the registrant to participate in any and all activities during the 2018-19 season. I/we hereby waive, release, absolve, indemnify and agree to hold blameless the Boston Americans, its organizers, sponsors, supervisors, participants and persons transporting my/our registrant to and from activities and any claims arising from an injury to my/our registrant. I/we assume all risks and hazards incidental to such activities and participation. I/we will furnish a birth certificate upon request of the League. I further give permission for the above applicant's name to be posted on the Boston Americans website if selected for additional tryouts or the team.

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