Family Size 3 SAN ANTONIO URBAN MINISTRIES MONTH_________________YEAR_______ AFTER SCHOOL KARE PAYMENT COUPON

____________________________________________ _______________________ ___________________________________

CHILD’S NAME ACCOUNT # SCHOOL

____________________________________________ _______________________

CHILD’S NAME ACCOUNT #

____________________________________________ _______________________

CHILD’S NAME ACCOUNT #

_______________________________ _______________________________________________

PARENT’S NAME STREET ADDRESS

MAIL PAYMENT TO: AMOUNT DUE: $521.00

AMOUNT DUE AFTER THE 5^TH $581.00

SAN ANTONIO URBAN MINISTRIES

AFTER SCHOOL KARE AMOUNT ENCLOSED: ______________

PO BOX 17469

SAN ANTONIO, TX 78217 CHECK NUMBER: ______________

YOUR CANCELLED CHECK IS YOUR RECEIPT

Family Size 3 SAN ANTONIO URBAN MINISTRIES MONTH_________________YEAR_______ AFTER SCHOOL KARE PAYMENT COUPON

____________________________________________ _______________________ ___________________________________

CHILD’S NAME ACCOUNT # SCHOOL

____________________________________________ _______________________

CHILD’S NAME ACCOUNT #

____________________________________________ _______________________

CHILD’S NAME ACCOUNT #

_______________________________ _______________________________________________

PARENT’S NAME STREET ADDRESS

MAIL PAYMENT TO: AMOUNT DUE: $521.00

AMOUNT DUE AFTER THE 5^TH $581.00

SAN ANTONIO URBAN MINISTRIES

AFTER SCHOOL KARE AMOUNT ENCLOSED: ______________

PO BOX 17469

SAN ANTONIO, TX 78217 CHECK NUMBER: ______________

YOUR CANCELLED CHECK IS YOUR RECEIPT