Reoccurring authorization form for After School Care

Name

First Name

Last Name

Email Address

Type of Card

Credit Card Number

Exp Date

CVC Code (3 digit code)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

By pressing submit you authorize Recreation Reimagined to process your child’s monthly tuition on the last day of each month.