Cool Before and Afterschool Program Randall STEM Academy

Transcription

1 Cool Before and Program Randall STEM Academy Payment Plan Agreement School Year A payment plan is available to parents/guardians wishing to register their child(ren) for the Before/ Program. The Payee agrees to the following noted fees charged to the credit card listed below. Monthly payment cycles will be scheduled to facilitate payments during the school year. Note: We do not prorate program fees or refund for snow days. Please note payment dates: September payment due at time of registration December Charged Tuesday, November 20 March Charged Wednesday, February 20 October Charged Thursday, September 20 January Charged Thursday, December 20 April Charged Wednesday, March 20 November Charged Saturday, October 20 February Charged Sunday, January 20 May & June Charged Saturday, April 20 Parent/Guardian Name: Parent/Guardian Date of Birth: Address: City: State: Zip: Cell Phone: Work Phone: Home Phone: Address: Program Participant name(s)/information: Child #1 Name: Date of Birth: Male/Female: Grade for school year: Child #2 Name: Date of Birth: Male/Female: Grade for school year: Child #3 Name: Date of Birth: Male/Female: Grade for school year: Child #4 Name: Date of Birth: Male/Female: Grade for school year: Payment Information (please print): Circle One: Visa MasterCard Name on Credit Card: Credit Card Number: Expiration Date: CSC Code: Authorized Cardholder Signature: Date: Authorization to participate and for Emergency Medical Treatment: I, as participant or parent/legal guardian of the above named child(ren), hereby give permission for his/her/my participation in the above listed activity(ies). I further advice without my prior approval, the rendering of any emergency medical treatment that may be necessary due to his/her/my participation in the activity(ies). Parent/Guardian Signature: Date:

2 Cool Before and Program - Randall STEM Academy Payment Plan Agreement School Year Please check the following program(s)/session(s) that you would like for the school year. NOTE: Any changes or cancellation to your selection can be made at any time. Please notify WPRF in writing of the change(s). September, due at time of registration x $ :30 pm Pick-up 9/4 9/28 (19 days) x $ x $ due at time of registration October, due on 9/20/ x $ :30 pm Pick-up 10/1 10/31 (21 days) x $ x $ Thursday, Oct x $28.00/day Friday, Oct x due on 9/20/18

3 November, due on 10/20/ x $ :30 pm Pick-up 11/1 11/30 (19 days) x $ x $ Wednesday, Nov x $28.00 due on 10/20/18 December, due on 11/20/ x $ :30 pm Pick-up 12/3 12/21 (15 days) x $ x $ Wednesday, Dec x Thursday, Dec x $28.00/day Friday, Dec x due on 11/20/18

4 January, due on 12/20/ x $ :30 pm Pick-up 1/2 1/31 (20 days) x $ x $ Monday, Jan x $28.00/day Tuesday, Jan x February, due on 1/20/ x $ :30 pm Pick-up 2/1 2/28 (20 days) x $ x $ March, due on 2/20/ x $ :30 pm Pick-up 3/1 3/22 (16 days) x $ x $ Monday, Mar x Tuesday, Mar x Wednesday, Mar x $28.00/day Thursday, Mar x Friday, Mar x due on 12/20/18 due on 1/20/2019 due on 2/20/2019

5 April, due on 3/20/ x $ :30 pm Pick-up 4/1 4/30 (21 days) x $ x $ Friday, Apr x $28.00 due on 3/20/2019 May/June, due on 4/20/ x $ :30 pm Pick-up 5/1 6/7 (27 days) x $ x $ due on 4/20/2019 NOTE: If your credit card information changes throughout the year, please contact the Main Office at (262) to update your payment plan form!