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B&A Payment Agreement Form
***A REGISTRATION FORM AND THE $40 REGISTRATION FEE (PER CHILD) MUST BE SUBMITTED BEFORE THIS FORM CAN BE FILLED OUT AND SUBMITTED***
Child's First Name *
Your answer
Child's Last Name *
Your answer
Grade level *
Select a membership for your child: *
Required
Out of School Full Day Add-On (check the dates you will "potentially" need care. There is no obligation now. Sign-ups will begin 2 weeks prior to each date. We must have at least 10 students signed up to offer care on these dates) *
Required
FORM of payment (select one) *
METHOD of payment (select one) *
By checking the box below, I understand that if tuition is not paid on-time as outlined in the ABS Before & After School Handbook, I will be charged a $15 late fee. I understand that failure to pay will result in dismissal from the program. I understand that a change to my account or withdrawal from the program requires a 2 week advance notice in writing. I understand that I will be charged a $25 insufficient fund fee for any returned payments. *
Required
The Full Name of the person filling out this Payment Agreement Form *
Your answer
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