Registration 2021

Parents First Name *

Parents Last Name *

Street Address *

City *

Phone Number *

Cell Phone Provider *

Email Address *

child’s name *

Child's Date of Birth * +

child’s name

Child's Date of Birth +

child’s name

Child's Date of Birth +

child’s name

Child's Date of Birth +

Start Date * +

please fill out the schedule for you child *

	schedule
Monday	schedule
Tuesday	schedule
Wednesday	schedule
Thursday	schedule
Friday	schedule

Will your child be on schools meal plan *

yes

no

We are excited to offer the safety, convenience and ease of Tuition Express®—a payment processing system that allows secure, on-time tuition and fee payments to be made from either your bank account or credit card.
ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT and CREDIT CARD I (we) hereby authorize Magical Palace of Knowledge to initiate credit card charges to the below-referenced credit card account for tuition and any fees on the account (Section A) OR, initiate debit entries to my (our) checking or savings account, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. Credit union members: please contact your credit union to verify account and routing numbers for automatic payments. There is a $1 transaction fee for payments with a checking or savings account. There is 2.75% fee for any and all Credit card payments

Card Holder Name

Street Address

City

State

Zip Code

Phone Number

Credit Card Number

Experation Date

Signature

clear

Todays Date +

First Name

Last Name

Street Address

City

State

Zip Code

Phone Number

Bank Name *

Bank Address *

Routing Number *

Account Number *

Account Type *

Please upload a voided check *

Authorized Signature *

clear

Todays Date +

Please Charge only *

Please use *

other comments