Specialized Billing Plan Request

Specialized Billing Plan Request
Please complete this form if you would like to be placed on a specialized billing plan. Once your request has been submitted, the Academy will let you know if it has been approved or denied within 48 hours.
Parent Name

First NameLast Name
Email address
example@example.com
Child's Name

First NameLast Name
What is your desired billing plan?
Other
Please write in the space below what day or due date you are requesting to make payments.(Ex. Bi-weekly payments on Tuesdays; Monthly payments on the 15th; Weekly payments on Fridays)
Signature
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Florida Catholic Conference Accredited School

Religious Exempt Status X01ES0063

The Holy Spirit Child Development Academy is a child care facility operating under an exemption pursuant to the laws of the State of Florida and is not subject to licensure or regulation by the Department of Children and Families.
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