Pre-Authorized Debit (PAD) Agreement

Form to be accompanied by Void cheque or Direct Deposit Form from online banking

"*" indicates required fields

Family Information (one form per child)

Your Name*

First Last

Child's Name*

First Last

Address*

Street Address City Province Postal Code

Email*

Phone*

Bank Account Information

Deposit Account Number*

Branch Transit: (5 digits)*

Bank Number: (3 digits)*

Account Type*

Chequing Account

Savings Account

Bank Name*

Bank Address*

Please upload a void cheque or bank form*

Accepted file types: jpeg, jpg, png, pdf, Max. file size: 32 MB.

Pre-Authorized Debit (PAD) Details

You, the Payor, authorize Foothills Creative Beginnings Preschool & ECS Association to debit the bank account identified above for the option checked below on the 1st of every month or the next business day, for the 2023-2024 school year, from September 1, 2023 to June 1, 2024. Notification of withdrawal will be received by payor 3 business days prior to the withdrawal date.

Program*

Kindergarten – program - $ 40.00 / month

Kindergarten – full payment one time - $400.00 / annually

Preschool Cochrane – 2 day program - $115.00 / month ($190.00 less $75 Affordability Grant)

Preschool Cochrane – 3 day program - $175.00 / month ($250.00 less $75 Affordability Grant)

Preschool Calgary - 4 day program - $235.00 / month ($310 less $75 Affordability Grant)

These services are for:*

Personal

Business

You, the Payor, may revoke your authorization at any time, by contacting the school via email to donnelle.watson@foothillscreative.org, subject to providing notice of 30 days. To obtain a sample cancellation form, or for more information on your right to cancel a PAD Agreement, contact your financial institution or visit www.cdnpay.ca.

Signature of Account Holder*

Account Holder Name*

Date*

Signature of Joint Account Holder (If Applicable)

Joint Account Holder Name

Date

You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, contact your financial institution or visit www.cdnpay.ca.

This field is for validation purposes and should be left unchanged.