YMCA of South Florida

Late Payment Acknowledgement Form
Date:

MonthDayYear
Date
Location:
Child's Name:

First NameLast Name
Parent Name:

First NameLast Name
Parent Email:
example@example.com
Finance Email:
Operations Email:
Parent Acknowledgement
Payment Past Due:

As of today, your account is past due. As a result, a late fee of $10 will be charged to your account. In order to continue service, a payment must be received within one business day from the date of this communication. Should a payment not be received, your child will not be permitted to attend the program until such time the balance is paid in full.

Any outstanding balance and applicable late fees will be added to the participant's YMCA account. Payments must be made through the family's online account and will not be accepted on-site at the time of pick-up.

Please note that payments are due on the 1st of each month. Refer to the Payment Selection Form you received at the time of registration.

If you have any questions or if you need additional information, please feel free to contact the Finance Department at 305-357-4000.

Participant Name: {childsName}

Parent Name: {parentName}

Parent Signature: {signature311}

Dated: {date217}
Parent Signature
Should be Empty: