[text_content "Please complete the form below to sign up, update or cancel your monthly Automatic Tuition Payment using the credit card information provided upon registration."]
Please Select An Option
ENROLL: I authorize The Dancing Lights Ballet School to automatically charge the credit card affiliated with my Jackrabbit.com account. The card will be charged for the monthly tuition amount on or after the 5th of each month until the end of the 2022-2023 school year.UPDATE: I want to update the monthly tuition amount.CANCEL: I want to cancel the monthly automatic tuition payment that is being deducted from The Dancing Lights Ballet School for the 2022-2023 school year.
Student Full Name(s)*
Monthly Tuition*
Parent / Guardian First Name*
Parent / Guardian Last Name*
Phone xxx-xxx-xxxx*
Email*
e-Signature*
I certify that I intend my electronic signature on this certification statement to be the legally binding equivalent of my traditional handwritten signature. I have read and understand the Terms & Conditions
Full Name*
Date*
17 Wood Street Suite 33 and 35 Middletown, DE 19709
Phone: 1.302.378.7003
Email: info@thedancinglights.com
Web: thedancinglights.com
