After School Payment Form

Please fill out this form and click submit.

Please enter your name, email address and your Children(s) Name(s) that are attending.

Name

*

Email

*

This address will receive a confirmation email

Children(s) Name(s)

*

Please select the month that your payment is applied to and then enter the payment amount listed on your invoice.

Payment Month

*

Please select one option.

September October November December January February March April May June

Payment Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit.

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