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Independence Jr. High Campus Registration
Student's Full Name
Last Name
,
First Name
Student Fees
Registration:
$75.00
Select:
Item Subtotal:
$0.00
Curricular Fees Grades 7th and 8th
Theater/Art/Foods:
$10.00
Quantity:
Item Subtotal:
$0.00
Band/Choir:
$30.00
Quantity:
Item Subtotal:
$0.00
German DLI Culture:
$10.00
Select:
Item Subtotal:
$0.00
Sewing:
$25.00
Quantity:
Item Subtotal:
$0.00
Lego Robotics:
$25.00
Quantity:
Item Subtotal:
$0.00
Lego Robotics Competition:
$15.00
Select:
Item Subtotal:
$0.00
Student Council:
$80.00
Select:
Item Subtotal:
$0.00
Shakespeare Competition:
$150.00
Select:
Item Subtotal:
$0.00
National Junior Honor Society:
$22.00
Select:
Item Subtotal:
$0.00
Homebase/Advisory:
$20.00
Select:
Item Subtotal:
$0.00
Extra-Curricular Fees Grades 6th- 8th
Boys and Girls Basketball:
$150.00
Select:
Item Subtotal:
$0.00
Cross Country:
$70.00
Select:
Item Subtotal:
$0.00
Boys and Girls Soccer:
$120.00
Select:
Item Subtotal:
$0.00
Boys and Girls Volleyball:
$110.00
Select:
Item Subtotal:
$0.00
6th, 7th, 8th Grade After School Band:
$100.00
Select:
Item Subtotal:
$0.00
Theater Production:
$25.00
Select:
Item Subtotal:
$0.00
HOSA:
$30.00
Select:
Item Subtotal:
$0.00
HOSA Conference:
$50.00
Select:
Item Subtotal:
$0.00
HOSA International Leadership Conference:
$1,250.00
Select:
Item Subtotal:
$0.00
Non-Waivable Fees
Athletic Sweatshirts:
$25.00
Select:
Item Subtotal:
$0.00
Technology Fees
Charger:
$25.00
Select:
Item Subtotal:
$0.00
Screen Replacement:
$75.00
Select:
Item Subtotal:
$0.00
Total Replacement:
$250.00
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% surcharge for foreign cards)
eCheck:
$0.49
Method of Payment:
Credit/Debit Card
eCheck
Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
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