Kids Club – 4th Grade Band

You are paying for 4th Grade Band for the 2020-2021 term.

Child's Name*
First Last
Child's Classroom Teacher*
Child's Cohort*
Parent/Guardian Name*
First Last
Parent/Guardian Email*
Parent/Guardian Phone*
Parent/Guardian #2 Name
Please only fill out if the second parent/guardian needs to be informed about Kids Club updates
First Last
Parent/Guardian #2 Email
Parent/Guardian #2 Phone
Choose Payment Option*
- Quarter-Payment ($250)
- Half-Payment ($500)
- Full Payment ($1,000)
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name