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After School Programs - Automatic Draft Enrollment / Change

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  2. This form will allow you to enroll or make changes to your autodraft status in Roanoke County's After School for Kids (A.S.K.) program and Ridge Kids after school program at Green Ridge Recreation Center. New enrollments and changes to your account require at least two weeks advance notice. If your account changes without notifying our office, this may result in your child (or children's) dismissal from the program.

    Automatic draft is required for participants in Ridge Kids. For all other programs, automatic draft via credit card is not required, however, enrollment fees are lower for parents utilizing this service. Automatic draft will occur every other week. If you choose to pay by check for the After School for Kids program, please do not fill out this form.

  12. After school site location*
  14. Please check method of payment (card may be either credit or debit)*

  22. By submitting this form, I authorize Roanoke County Parks, Recreation and Tourism's to initiate automatic withdrawal of payments from my account. Payments will occur bi-weekly. In the case of closure of the account, I agree to reimburse the A.S.K. or Ridge Kids programs for the amount of fees owed and update my payment information immediately.*

    23. Leave This Blank:

  25. This field is not part of the form submission.