SIPlive: Ogden Preparatory

Student's Name	First Name		Last Name
Student's Name

School Fees

Registration Fee:

$70.00

Select:

Item Subtotal:

$0.00

Replacement Name Tag:

$5.00

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Item Subtotal:

$0.00

Fine Art:

$20.00

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Item Subtotal:

$0.00

Exploring Technology:

$20.00

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Item Subtotal:

$0.00

Music:

$20.00

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Item Subtotal:

$0.00

Science Electives:

$20.00

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Item Subtotal:

$0.00

Triathlon (Yearly):

$72.00

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Item Subtotal:

$0.00

Triathlon (Monthly):

$8.00

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Item Subtotal:

$0.00

Weight Training (Per Semester):

$25.00

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Item Subtotal:

$0.00

Weight Training (Yearly):

$50.00

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Item Subtotal:

$0.00

PE Uniform - Shirt:

$8.00

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Item Subtotal:

$0.00

PE Uniform - Shirts (Set of 2):

$15.00

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Item Subtotal:

$0.00

Junior High Yearbook:

$35.00

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Item Subtotal:

$0.00

Field Trip:

Item Subtotal:

$0.00

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Name of Field Trip	[10]

School Spirit Clothes:

Item Subtotal:

$0.00

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Description of School Clothes	[9]
Description of School Clothes	[10]

Lunch Payments:

Item Subtotal:

$0.00

Lunch Note	[1]
Lunch Note	[2]
Lunch Note	[3]
Lunch Note	[4]
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Lunch Note	[6]
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Lunch Note	[8]
Lunch Note	[9]
Lunch Note	[10]

Miscellaneous Fee:

Item Subtotal:

$0.00

Please give a description of what the payment is for				[1]
Please give a description of what the payment is for				[2]
Please give a description of what the payment is for				[3]
Please give a description of what the payment is for				[4]
Please give a description of what the payment is for				[5]
Please give a description of what the payment is for				[6]
Please give a description of what the payment is for				[7]
Please give a description of what the payment is for				[8]
Please give a description of what the payment is for				[9]
Please give a description of what the payment is for				[10]

Sports

Cross Country:

$20.00

Select:

Item Subtotal:

$0.00

Volleyball:

$30.00

Select:

Item Subtotal:

$0.00

Basketball:

$50.00

Select:

Item Subtotal:

$0.00

Soccer:

$50.00

Select:

Item Subtotal:

$0.00

Ultimate Frisbee:

$10.00

Select:

Item Subtotal:

$0.00

Total:

$0.00

Payer's Information

First Name:		Last Name:
Phone:		Email:

Payment Information

Method of Payment:

Processing Fees:

Credit cards: 3% plus $0.50 ($1.50 min)
(+1.5% processing fee for foreign cards)
eChecks: $0.49

	Update name from Payer's Information
Name of Individual on Checking Account: Name of Individual on Savings Account: Name of Business on Checking Account:
Bank Routing Number:
Bank Account Number:

Credit Card Number:	(Type number or swipe with cursor in this empty field)
Expiration Date:	/
Card ID (CVV2/CID) Number:	What is the Card ID?

Cardholder Information (exactly as it appears on your statement)
	Update from Payer's Information
Cardholder's Name:

Billing ZIP/Postal Code:

Please be aware that payments will reflect on your statement as

Schools 800-764-0844 Clinton UT


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