PS 321 Afterschool Payment Form Use this secure form to purchase the PS 321 afterschool programs in which your child has been enrolled. If you have children in the same club, you must fill out this form for each child. Ex: If you have 2 children in Ball Games, you must submit once for Ball Games and fill it out again for the second child in Ball Games. DO NOT PAY FOR AFTERSCHOOL UNTIL YOU HAVE BEEN TOLD THAT YOUR CHILD IS ENROLLED IN A CLASS! (This secure form has an SSL certificate and passes your account information through to paypal via their api. Your account information is not stored on the site or by the school.) Name* First Last Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Child's Name* First Last Class Number (from 2019-2020 school year)*Summer Program* Summer Instrument Rental ($100) Summer Instrument Rental ($100) Price: $100.00 TotalPLEASE MAKE SURE THIS TOTAL REFLECTS THE COURSES YOU ARE PAYING FOR BEFORE PROCEEDING. $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name