CALI Center Monthly Payment Form

1
Student Name
First Name
Last Name
2
Parent/Guardian Name
First Name
Last Name
3
Parent/Guardian Email
example@example.com
4
Phone Number
Please enter a valid phone number.
5
Parent/Guardian Signature
Clear
6
Date Signed
Date
Month
Day
Year
7
My Products
prevnext( X )
My Bag
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My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
Monthly FeeAfter School Tuition
$250.00Edit
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Quantity
Bi-Monthly FeeAfter School Tuition (2 months)
$500.00Edit
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Quantity
Quarterly FeeAfter School Tuition (Quarterly)
$750.00Edit
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Quantity
Sibling FeeSibling Discount
$200.00Edit
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Drama Club MonthlyMonthly Payment Option
$100.00Edit
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Total cost $0.00
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Payment Methods
Debit Or Credit Card
Select PayPal Method
Choose from one of the PayPal options to make your payment.
Should be Empty: