Parent Membership Pg 1

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"Payment Protection" Services!

Paycare Program

About Us
Paycare Pays Child/Family Fees For...
Join Today at No Up-front Cost!
Member Portal
- Administrative Only
- Parent Pay Incentives
Contact Us

About Us
Paycare Pays Child/Family Fees For...
Join Today at No Up-front Cost!
Member Portal
- Administrative Only
- Parent Pay Incentives
Contact Us

PayCare

Parent Membership Agreement

MEMBERSHIP FEES

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

(*No up-front, out-of-pocket fees to Parents)

SERVICE

To Create the Customized “Parent’s Promise” Plan required for parents to access Pay Incentives to academic, educational, and extra-curricular facilities, transportation, and healthcare for their child(ren) through the 12th Grade; To receive and forward ‘qualifying’ Referral Slips for processing of Pay incentives. Fees can be replenished over a period of 12 months.

Name*

Membership Type(s) *

Plus (Childcare thru Grade 12)Home (Rent/Mortgage/Utilities)Medical (Doctor Visits & Co-pays)Scholar (College & Specialty Schools)Auto (Repairs & Down 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 “Parent’s Promise” membership Card to access future assistance, given that the current “Parent’s Promise” Plan is being followed. There is no pre-set limit for assistance.Upon signing a “Parent’s Promise” Plan, parent can complete a Referral Slip with their facility (must be signed by parent and facility) to access “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 a qualifying Referral Slip and the facility and parent must both 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; Review, agree to, and sign the “Parent’s Promise” Plan; and sign a Referral Slip in order for processing to occur.

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, annuallyOption: $10.00 “Parent’s Promise” Card renewal fee, annually$3.00 fee for any additional or lost “Paycare” CardCustomized per “Parent’s Promise” Plan; including Renewed Plans10% Convenience fee per Pay Incentive made on your behalfOption: $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)*

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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 the best life outcomes possible.

(Non-member, Referring 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!)

|Integrity |Execution |Vision

Copyright ©2019

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