After School Academic Program Weekly Payment Form

Afterschooler's Name:	*
Afterschooler's Name
Afterschooler's Name
Afterschooler's Name
Fee Amount - For Week Of:	*
Fee Amount Submitted:	* $
Reminder: A five dollar ($5.00) late fee per child will be imposed if the payment is submitted after 6:00pm on Friday.
Your Email Address	*
Total	$