HPA Electronic & Checks Payment Authorization Agreement for the School Year 2025-2026

Electronic & Checks Payment Authorization Agreement for the School Year 2025-2026

IMPORTANT: Please use this form and sign up for automatic recurring electronic payments for the Healing Power of Art online program on the 1st of each month or to indicate that you will pay the full amount by check.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Section I
Please select one.*

I would like to register for The Healing Power of Art I.I would like to register for Healing Through Art II (only for students who have already completed Healing Through Art I).
Please select one.*

I will pay a monthly fee of $120 with a credit/debit card from October 2025-June 2026 (9 months), and agree to the 3% card fee. A payment form will be emailed to me separately.I will pay the full amount of $1,080 with a credit/debit card, and agree to the 3% card fee. A payment form will be emailed to me separately.I will pay with 1 check in the full amount of $1,080. The check should be made out to “BACWTT” and mailed to P.O. Box 21265, El Sobrante, CA 94820.
Section II

Saturday online classes take place from 10am-12:30pm Pacific Time, USA near the beginning of each month and allow live participation. Recordings of classes will be available if you are unable to attend.

Midweek feedback meetings at the end of each month run at multiple times of the day to accommodate different time zones.

HPA 1 Saturday Class	HPA 1 Tuesday Check-In	HPA 2 Saturday Class	HPA 2 Thursday Check-in
Oct 4	Oct 28	Sep 27	Oct 30
Nov 1	Nov 25	Nov 1	Nov 27
Dec 6	Dec 30	Dec 6	Jan 2
Jan 3	Jan 27	Jan 3	Jan 29
Jan 31	Feb 24	Jan 31	Feb 26
Mar 7	Mar 31	Mar 7	Apr 2
Apr 4	Apr 28	Apr 4	Apr 30
May 2	May 26	May 2	May 28
May 30	Jun 30	May 30	Jul 2

Please select your preferred timeslot for the feedback meetings. If none of these options work, please email ken@bacwtt.org and pamwhitman@yahoo.com.*

9:30am-11am (Pacific Time, USA)4pm-5:30pm (Pacific Time, USA)6:30pm-8pm (Pacific Time, USA)None of these work. I will contact Ken and Pamela.
Signature of Applicant*

First NameLast Name
Date Signed*

MonthDayYear
Date
Should be Empty:

Electronic & Checks Payment Authorization Agreement for the School Year 2025-2026

Section I

Section II