Student's Name
First Name
Last Name
School Fees
Registration Fee:
$70.00
Select:
Item Subtotal:
$0.00
Replacement Name Tag:
$5.00
Select:
Item Subtotal:
$0.00
Fine Art:
$20.00
Select:
Item Subtotal:
$0.00
Exploring Technology:
$20.00
Select:
Item Subtotal:
$0.00
Music:
$20.00
Select:
Item Subtotal:
$0.00
Science Electives:
$20.00
Select:
Item Subtotal:
$0.00
Triathlon (Yearly):
$72.00
Select:
Item Subtotal:
$0.00
Triathlon (Monthly):
$8.00
Select:
Item Subtotal:
$0.00
Weight Training (Per Semester):
$25.00
Select:
Item Subtotal:
$0.00
Weight Training (Yearly):
$50.00
Select:
Item Subtotal:
$0.00
PE Uniform - Shirt:
$8.00
Select:
Item Subtotal:
$0.00
PE Uniform - Shirts (Set of 2):
$15.00
Select:
Item Subtotal:
$0.00
Junior High Yearbook:
$35.00
Select:
Item Subtotal:
$0.00
Field Trip:
$
Item Subtotal:
$0.00
Name of Field Trip
[1]
Name of Field Trip
[2]
Name of Field Trip
[3]
Name of Field Trip
[4]
Name of Field Trip
[5]
Name of Field Trip
[6]
Name of Field Trip
[7]
Name of Field Trip
[8]
Name of Field Trip
[9]
Name of Field Trip
[10]
School Spirit Clothes:
$
Item Subtotal:
$0.00
Description of School Clothes
[1]
Description of School Clothes
[2]
Description of School Clothes
[3]
Description of School Clothes
[4]
Description of School Clothes
[5]
Description of School Clothes
[6]
Description of School Clothes
[7]
Description of School Clothes
[8]
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]
Lunch Note
[5]
Lunch Note
[6]
Lunch Note
[7]
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:
Visa
MasterCard
Discover Card
Personal Checking
Personal Savings
Business Checking
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:
01
02
03
04
05
06
07
08
09
10
11
12
/
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
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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