Parent Membership Pg 1

"Payment Protection" Services!

Paycare Program

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Paycare Pays Child/Family Fees For...
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- Parent Pay Incentives
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PayCare

Parent Membership Agreement

MEMBERSHIP FEES

$125.00 Annually Per Parent, Per Child up to 12th Grade

(*No up-front, out-of-pocket membership fees for parents)

CONSULTATION SERVICE

To create the customized “Parent’s Promise” Plan required for parents to access to academic, educational,

and extra-curricular facilities, transportation, housing and healthcare 'Pay Incentives' for their child(ren)

from birth through the 12th Grade; To Consult on the processing of obtaining 'Pay incentives'.

'Pay Incentives' can be reimbursed over a 12-month membership period.

[PAGE 1] Name

Am I Eligible For Membership?*

(*all boxes must be checked)

I am a parent/caregiver (*Non-parents allowed through 12/31/23).

I have monthly income of $1920.00 or more (any source allowed).

All my information is verifiable & I have credit of 400 score or more.

I have a checking account at a brick-n-mortar bank/credit union.

Membership Type(s) *

Plus (Childcare thru Grade 12 & Extra-curricular)

Home (Rent/Mortgage/Utilities/Repairs)

Medical (Doctor Visits & Co-Pays)

Scholar (Tuition/Textbook/etc. for College & Specialty Schools)

Auto (Repairs, Down payments & Past-due Payments)

Number of Children*

Phone Number*

Email Address*

SERVICE (*Check All):*

Upon joining, parent will sign a Paycare-Plus “Parent’s Promise” Plan and receive a “Paycare” membership card to access future assistance, given that the current “Parent’s Promise” Plan is being followed. There is no pre-set number of times to receive assistance.

Upon signing a “Parent’s Promise” Plan, parent commits to reimbursing their 'Family Fund' for continued access to set -aside "Pay Incentives".

Within 24 hours, parent’s “Parent’s Promise” Plan will be created; Within 7 days, the “Paycare” membership card will be sent out;

within 3 to 5 business days, the "Pay Incentive" can be processed.

For Pay incentives to be processed, the parent must have reviewed, agreed to, and signed the “Parent’s Promise” Plan, submitted all required documentation (shown below) and have a current membership status.

Parent must fully complete the Paycare-Plus membership agreement, submit a PHOTO I.D. COPY, BANK STMT(ALL PAGES), PAYSTUB, DEBIT CARD COPY and ‘VOID’ CHECK.

OPTIONAL FEES: Any applicable fees can be put on Paycare Card and be 'rolled into' Pay Incentive (*Check All):

$125.00 membership fee Per Parent, per child, annually

Option: $10.00 “Parent’s Promise” Card renewal fee, annually

$3.00 fee for any additional or lost “Paycare” Card

Customized per “Parent’s Promise” Plan; including Renewed Plans

10% Convenience fee per Pay Incentive made on your behalf

Option: $100 Convenience Fee if pmts go past 12-mo mbrshp

**Signatures** (Check All): *

This Membership Agreement shall cover a period of 1 year, to be automatically renewed annually, unless a written cancellation is received by either Party 30 days prior to the automatic renewal date. ‘Pay incentives’ credits must be used in membership period. Any suspected or tracked abuse will result in revoked membership and forfeit of fees. If any provisions of this Agreement are breached, the Parties agree to Mediation services to settle any and all disputes.

By checking/completing the boxes below, I agree that the electronic digitized signature(s) I apply on the following documents are representations of my signature and are legally valid and binding as if I had signed the document with ink on paper in accordance with the Uniform Electronic Transactions Act (UETA) and the Electronic Signatures in Global and National Commerce Act (E-SIGN) of 2000.

Disclosure Acknowledgement*

By checking this box, I acknowledge I have reviewed & understand the "How It Works" Page on the Paycare website.

E-Signature Date*

E-Sign (Type Your Name)*

Thank you for contacting us. We will get back to you in 24 to 48 business hours! Don't forget to go back & complete links #2 and #3.

Paycare Services:

Paycare Home

Mission:

To prevent finances from being an obstacle between families with children/youth and the most stable housing possible.

(Funds paid directly to Residential Leasing facilities on behalf of families!)

Paycare 'Starter'

Mission:

To prevent finances from being an obstacle between children/youth, of even the most modest circumstances, and access to the best life outcomes possible.

(Non-MemberReferring Facilities' funds are not paid directly to facilities, but paid directly to the families' accounts.)

Paycare Plus

Mission:

To prevent finances from being an obstacle between children/youth, from birth to Grade 12, and the best

extra-curricular/education possible.

(Funds paid directly to Childcare & extra-curricular facilities, up to child's 12th grade!)

Paycare Scholar

Mission:

To prevent finances from being an obstacle between children/youth and the best college education possible.

(Funds paid directly to post-secondary education facilities on behalf of families!)

Paycare Medical

Mission:

To prevent finances from being an obstacle between children/youth and the best healthcare possible.

(Funds paid directly to medical, clinical, and health facilities on behalf of families!)

Paycare Auto

Mission:

To prevent finances from being an obstacle between families with children/youth and dependable transportation.

(Funds paid directly to auto repair and sales dealerships on behalf of families!)

[**Scroll up, slightly, to "Paycare Services" to select from 6 service(s) for your Facility!**]

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