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*ABDParent/Guardian Name* First Last Parent/Guardian Email* Parent/Guardian Phone*Parent/Guardian #2 NamePlease 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 PhoneChoose Payment Option*Quarter-Payment ($250)Half-Payment ($500)Full Payment ($1,000)Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name