I hereby authorize WCRB Karate at Blue Bird Academy to charge the above account and to apply said charges toward the payment of tuition for child named above. Said charge authorization is to be in an amount equal to monthly tuition in effect at this time.

I understand that it shall remain my obligation to notify WCRB Karate at Blue Bird Academy in writing 30 days in advance of my intent to terminate this agreement. If the above card is declined for any reason the card holder will be responsible for all tuition, late fees or other charges that may occur.