Huntersville Family Fitness & Aquatics


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Huntersville Family Fitness & Aquatics requires the following information and your authorization to charge your credit, debit or checking account for the weeks your child(ren) are attending our program. Child(ren)'s Name: _________________________________________________________________________________ Name as it appears on the card: ____________________________________________________________________ Credit Card Type: q Visa q MasterCard Credit Card # ____________________________________________________________ Name as it appears on Checking Account: ____________________________________________________________ Routing # ________________________________________ Bank Account # __________________________________ Charge Authorization Form Date q June 26 - June 29 $____________ q July 10 - July 13 $____________ Enter the rate as it applies to your camper by each week that you wish to enroll your camper. Empower Sports Empower Sports Tuition: Member - $99.00 Non-Member - $109.00 No additional child discount offered. R8 Total of the weeks selected $ __________ 20% of the total weeks chosen $ __________ * Registration fee $ __________ Total due at registration $ __________ By signing below, I hereby authorize HFFA to charge the above listed credit card for the following: ________ Non- refundable registration fee ________ Non-refundable 20% deposit ________ Any remaining balance for each week of camp indicated above for my child(ren) ________ I understand this information is confidential and will be kept as a part of my records. I will notify HFFA if I change financial institutions or credit card numbers so that my payment is not delayed. Credit card declines will result in a $25.00 processing fee so please make sure you notify us immediately if your card has been replaced for any reason. Withdrawal between May 1st through June 1st will be charged for camps at a rate of 50%. Any withdrawls made after June 1st will need to be made NO LATER than the Monday, 2 weeks prior to the start of the registered camp week in order avoid a full charge for the camp. Proper notification will confine payment requirement to 50% of the cost of each weeks camp. Signature:__________________________________________________________ Date:______/______/20______ If you have selected Member Pricing enter your Key Tag # here_____________

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