Credit Card Authorization Form

Please fill out the form below, or if you prefer, you can print it out and bring it with you.

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I acknowledge that I am responsible to make timely payments of my balances due on my account. I understand that a 10% late fee of any balance due will be charged to me if outstanding payments are not made by the 15th day of each month. I further understand that a $20 fee will be charged by MMSD for any returned checks.

I authorize MMSD to initiate electronic payments for any balance due on my MMSD account, including registration fee, monthly tuition, recital costumes, dance shoes & attire, recital tickets, and any other competition or performance fees. Any time MMSD makes a charge to my credit card, proof of payment will appear on my account and I will receive an e-mail receipt that payment has been processed. The authority I give to automatically charge my payment information on-file will remain in effect until I un-enroll my child from dance classes at MMSD, or I notify MMSD to terminate the authorization. If for whatever reason, payments cannot be processed to my payment information on-file, I will receive an email notifying me of this and requesting that I contact MMSD with updated credit card information. I will make every effort to notify MMSD any time my credit card information that is on file with MMSD changes.

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Any Questions?

If you have questions please email or call:
info@missmariadance.com | 617-744-6095

Miss Maria’s
School of Dance

550 Arsenal Street
Watertown, MA 02472
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