Tuition Express Form

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One Per Family

Family Last Name___________________

CHRIST CHURCH PRESCHOOL & KINDERGARTEN 2018-2019 Payment Options & Authorization Please Choose Option (A) or (B) for Payments to Christ Church Preschool & Kindergarten (“CCK”): (Initial Here)

(Initial Here)

(A) Payment by Personal Check: I/We plan to pay our tuition by monthly / semi-annual / annual (circle one) Personal Check instead of payments through Tuition Express. (B) Payment by Tuition Express: I/We hereby authorize 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 20182019 school year. To properly affect the cancellation of this agreement, I/we are required to give 10 days written notice.

(Initial Here)

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

Payment Frequency

Draft Schedule



Monthly (amounts based on table below)

On or about the 1st of Sept., Oct., Nov., and Dec. 2018 AND On or about the 1st of Jan., Feb., March, April and May 2019

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Semi-Annual (amounts based on table below)

On or about the 7th of September 2018 AND On or about the 2nd of January 2019

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Annual (amounts based on table below)

On or about September 7th 2018

(Select One )

2018-2019 Toddlers Twos (2 Day) Twos (3 Day) Threes (3 Day) Threes (4 Day) Fours (4 Day) Fours (5 Day) Kindergarten

(Initial Here)

Monthly $270 $280 $325 $345 $390 $400 $445 $540

Semi-Annual $ 1,215.00 $ 1,260.00 $ 1,462.50 $ 1,552.50 $ 1,755.00 $ 1,800.00 $ 2,002.50 $ 2,430.00

Annual $ 2,430 $ 2,520 $ 2,925 $ 3,105 $ 3,510 $ 3,600 $ 4,005 $ 4,860

Student’s Names & Age Groups:

(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 (Teacher Appreciation, Family Night, Camp, 2019-2020 Registration Fee and Advanced Tuition).

Bank Account for Tuition Express: (write “Account on File” if CCK has the correct bank information from 2017-18; 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) Account Holder Name: Account Holder Signature: Example :

Please staple your voided check here.

Date: