PS 321 Band

PS 321 Band Payment Page

Child's Name(Required)

First Last

Child's Classroom Teacher/Class #(Required)

Parent/Guardian #1 Name(Required)

First Last

Parent/Guardian #1 Phone(Required)

Parent/Guardian #1 Email(Required)

Enter Email Confirm Email

Parent/Guardian #2 Name

First Last

Please only list a second parent if they need to be updated on Kid's Club news.

Parent/Guardian #2 Phone

Parent/Guardian #2 Email

Enter Email Confirm Email

PS 321 Band(Required)

Half Payment (2nd half due in Feb)- $400.00

Full Payment - $800.00

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name