SA Independence Jr. High/Elem EV

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Independence Jr. High Campus Registration

Student's Full Name	Last Name	,	First Name
Student's Full Name

Student Fees

Yearbook:

$30.00

Quantity:

Item Subtotal:

$0.00

Curricular Fees Grades 7th and 8th

Spanish 2:

$10.00

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Item Subtotal:

$0.00

Band:

$55.00

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Item Subtotal:

$0.00

German DLI Culture:

$10.00

Select:

Item Subtotal:

$0.00

Sewing/ Foods:

$20.00

Quantity:

Item Subtotal:

$0.00

Lego Robotics Class Fee:

$10.00

Select:

Item Subtotal:

$0.00

Student Council:

$100.00

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Item Subtotal:

$0.00

Shakespeare Competition:

$200.00

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Item Subtotal:

$0.00

Art / Sculpting:

$20.00

Quantity:

Item Subtotal:

$0.00

Extra-Curricular Fees Grades 6th- 8th

Boys and Girls Basketball:

$170.00

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Item Subtotal:

$0.00

Cross Country:

$90.00

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Item Subtotal:

$0.00

Boys and Girls Soccer:

$140.00

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Item Subtotal:

$0.00

Boys and Girls Volleyball:

$130.00

Select:

Item Subtotal:

$0.00

6th, 7th, 8th Grade After School Band:

$100.00

Select:

Item Subtotal:

$0.00

HOSA state and local chapter dues:

$15.00

Select:

Item Subtotal:

$0.00

Non-Waivable Fees

Technology Fees

Screen Replacement:

$75.00

Select:

Item Subtotal:

$0.00

Total:

$0.00

Parent/Guardian Information

First Name:		Last Name:
Phone:
Email:

Please be aware that payments will reflect on your statement as

CBT*SUMMIT ACADEMY and the service fee as CBT*SVC FEE SUMMIT A.

Payment Information:

Processing Fee Rates:
Cards:	3% plus $0.50 ($1.50 min) (1.5% additional service fee for foreign cards)
eCheck:	$0.49

Method of Payment:	Credit/Debit Card eCheck
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