Tuition Express Form

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One Per Family

CHRIST CHURCH PRESCHOOL & KINDERGARTEN 2017-2018 Payment Options & Authorization Please Choose Payment Option (A) or (B): (Initial  Here)    

(A) Payment  by  Personal  Check:    I/We  plan  to  pay  our  tuition  by  monthly  /  semi-­‐annual  /  annual  (circle  one)   check  instead  of  payments  through  Tuition  Express.   (B)  Payment  by  Tuition  Express:  I  hereby  authorize  Christ  Church  Preschool  &Kindergarten  (“CCK”)  through   Tuition  Express  to  initiate  debit  entries  to  my/our  Checking  or  Savings  Account  indicated  below.    This   authorization  is  to  remain  effective  with  CCK  for  the  2017-­‐2018  school  year.    To  properly  affect  the  cancellation  of   this  agreement,  I/we  are  required  to  give  10  days  written  notice.  

(Initial  Here)  

 

(Initial  Here)  

           (B)(1)  I/we  give  permission  for  CCK  to  initiate  debit  entries  for  the  following  tuition  amounts  with  the                    following  frequency:  

 

Selection  

Amount  

Payment  Method  

(Select  One  )  

(Fill-­‐in  based  on  table  below)  

Draft  Schedule  

o  

Monthly  Amount  

$  __________________  

On  or  about  the  1st  of  Sept.,  Oct.,  Nov.,  and  Dec.  2017  AND   On  or  about  the  1st  of  Jan.,  Feb.,  March,  April  and  May  2018  

o  

Semi-­‐Annual  Amount  

$  __________________  

On  or  about  the  7th  of  September  2017  AND   On  or  about  the  2nd  of  January  2018  

o  

Annual  Amount  

$  __________________  

On  or  about  September  7th  2017  

2017-­‐2018   Toddlers   Twos  (2  Day)   Twos  (3  Day)   Threes  (3  Day)   Threes  (4  Day)   Fours  (4  Day)   Fours  (5  Day)   Kindergarten  

   

(Initial  Here)  

Monthly   $265   $275   $320   $340   $385   $395   $440   $535  

Semi-­‐Annual   $  1,192.50   $  1,237.50   $  1,440.00   $  1,530.00   $  1,732.50   $  1,777.50   $  1,980.00   $  2,407.50  

Annual   $  2385   $  2,475   $  2,880   $  3,060   $  3,465   $  3,555   $  3,960   $  4,815  

                 

Student’s  Names  &  Age  Group:          

  (B)(2)    I/we  give  permission  for  CCK  to  initiate  debit  entries  for  other  items  throughout  the  year  as  I/we     Indicate  at  that  time  (i.e.,  Teacher  Appreciation  donations,  Family  Night  meals,  Camp  Tuition).  

  Bank  Account  for  Tuition  Express:  (write  “Account  on  File”  if  CCK  has  the  correct  bank  information  from  2016-­‐17;   otherwise,  please  complete  the  following  to  indicate  the  bank  account  to  use  for  Tuition  Express)    

Bank  Name:   Account  #  (see  example  below)  

       

Routing  #(see  example  below)    

Example:

 

 

Account  Holder  Name:  

 

 

Account  Holder  Signature:    

 

 

Date:  

 

 

-Please staple your voided check here.-