5th Grade Advanced Band Payment Form

Child's Name(Required)

First Last

Child's Class # or Teacher's Name(Required)

Parent/Guardian Email(Required)

Enter Email Confirm Email

Instrument(Required)

Please list the full name and phone number of those who are authorized to pick up your child after school:(Required)

Does your child have any allergies or special needs to consider?(Required)

5th Grade Advanced Band(Required)

$400 - Half Payment (2nd half due in Jan)

$800 - Full Payment

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name