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Homewood-Flossmoor Park District AM Club and Extra Innings Credit Card Installment Agreement 2012-2013 Registration Fees Program AM Club Extra Innings Kindergarten Adventures Kindergarten Extra Innings Total due:


Per Child $20 $30 $30 $30

1st Child


AM Club $179 $145 Extra Innings $267 $220 Kindergarten Adventures $177 $143 Kindergarten Extra Innings $395 $323 The total monthly payment that will be charged on your credit card on the 20th day of each month:



By signing this agreement, I agree to pay for the AM Club, Kindergarten Adventures, and/or Extra Innings Programs with the Homewood-Flossmoor Park District in monthly installments. The first installment payment will include the registration fee and is due when this contract is signed; the remaining monthly payments are due on the 20th of each succeeding month through April 20, 2013. I understand that I may prepay this contract in full at any time before maturity. AUTOMATIC PAYMENT PLAN: I agree to make my monthly payments under this contract, by: Credit Card _________________________________ Visa Exp. Date _____________________



1. Do not sign this agreement before you read it or if it contains any blank spaces. 2. You are entitled to an exact copy of the agreement you sign. 3. Under the law you have the right, among others, to pay in advance the full amount due. By signing below, you acknowledge receipt of a fully completed copy of this contract, signed by both you and the Park District, and a copy of the rules and regulations now in effect. Child’s Name: _______________________________ School: _____________________________ Signature: _____________________________________________ Date: _____________20_____ Name: __________________________________________________________________________ Address: ________________________________ City: ________________ Zip code: __________


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