School Day Supervision & Support Program

School Day Program - Registration Form

General Information

Champions name *

First

Last

School Name *

If your child's school has multiple locations, please specify the location as well

Grade *

Date of Birth *

Gender *

Parent's Name *

First

Last

Parent's Mobile Number *

Alternate Number

Parent's Email Address *

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Payment Information

Payment Method *

Card Number *

Name as it appears on card *

Expiration Date *

Zip Code *

Amount Payable Information

Details the card will be Authorized for

How many Days per week would you like to enroll for: *

Set-up Fee *

$ 30.00

Please select to agree on the set-up fee

Recurring charge start date *

Sept 19th, 2020

The recurring amount will begin on Saturday.

Authorization

Signature *
I hereby agree to Auto-pay.
No signature required for online Authorization.

Refund Policy *
I agree to refund policy (Refunds are only considered if Sapience cannot provide the service that was purchased)
If School Starts In-person classes, then parents are not liable to complete the program until the 1st semester.
No signature required for online Authorization.

Website

Sapience School Day – Registration Form

School Day Program - Registration Form

General Information

Payment Information

Amount Payable Information

Authorization