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Summer Camp Credit Card Authorization Form
Key Point Christian Academy | 609 Brickell Ave. Miami, FL 33131
FINANCE DEPARTMENT
Ms. Beatriz Abelenda
444 Brickell Ave
Suite 719
Miami, FL 33131
Ph: 305-680-2574
Email:
accountsreceivable@keypointschools.com
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* Indicates required question
Email
*
Your email
Student 1 - Name (first, last name):
*
Your answer
Student 2 - Name (first, last name):
Your answer
Student 3 - Name (first, last name):
Your answer
Name of the Person Responsible for Paying Summer Camp Fees (first, last name):
*
Your answer
Relationship to the Child:
*
Your answer
Mobile:
*
Your answer
Card Type:
*
AMEX
VISA
MASTER CARD
Other:
Name on the Card:
*
Your answer
Card Number:
*
Your answer
Expiration Date:
*
MM
/
DD
/
YYYY
CVC or Security Code:
*
Your answer
Billing Address (city, state, zip code):
*
Your answer
CREDIT CARD CHARGE WILL APPEAR ON YOUR STATEMENT AS KEY POINT CHRISTIAN ACADEMY
I, authorize Key Point Christian Academy to charge this credit card for the following:
*
Summer Camp Registration Fee
Summer Camp Fees
Summer Camp T-Shirt
Summer School - Enrichment Program | Failed Course | Attendance
Summer Tutoring
Required
I have read, understand, and I agree with all the terms of this contract/agreement.
ADDITIONAL FEE
A 2.5% handling fee will be charged to your account in addition to your invoice.
*ACH available upon request with no additional fee.
Please contact Ms. Beatriz from the Finance Department at
accountsreceivable@keypointschools.com
to request the authorization form.
Cardholder's Name/Signature:
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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