Tuition & Fees Payment Form
Parent Name
*
First Name
Last Name
Parent Email
*
example@example.com
Parent Phone Number
*
Please enter a valid phone number.
Student Name
*
First Name
Last Name
Payment Purpose
*
EX: Tuition, laptop fee, etc.
Payment Amount
*
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next
( X )
USD
Enter the amount you wish to pay in USD.
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
Optional Notes:
By signing below, I authorize Cumberledge Academy LLC to charge the payment amount I have entered above. I certify that I am the authorized user of the payment method provided and that I am making this payment voluntarily.
*
Date
*
-
Month
-
Day
Year
Date
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