Credit Card Authorization Form

2016 - 2017 School Year

Payments for after school care must be made by the 1st of the month. The Boys & Girls Club of Burbank and Greater East Valley will automatically charge your credit card/debit card on the 1st of the month. All inquiries/changes should be directed to Mira Shah who can be reached directly at 818-842-9333 ext 111 or at mirashah@bgcburbank.org. Please note the following points:

- August Fees will automatically be adjusted since it is half a month and will be charged the week of August 15th
- You must notify our office at least 5 days before the 1st of the month if your child is no longer attending the program. Please note, we cannot hold your spot for you and if you re enroll your child, you must pay the registration fee again. You can provide your notification to Mira Shah via email at mirashah@bgcburbank.org or by phone at 818-842-9333 ext 111.
- If you receive a new credit card or your credit card expires, you can use this form to update your credit card information or you can contact our office . If your card is declined and we cannot get a hold of you within 5 business days, then you will be responsible for a $15 late charge.
- We are not responsible for bank charges due to a decline or overdraft.

    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    Must be a number greater than 0
    This is a required question
    Must contain @
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question