SA Independence Jr. High/Elem EV
             
Independence Jr. High Campus Registration

Student's Full NameLast Name,First Name
 
Jr. High Registration Fees:   $100.00   Quantity:   Item Subtotal:  
$0.00
Yearbook:   $30.00   Quantity:   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

Schools 800-764-0844 Clinton UT

Payment Information
Method of Payment:
Processing Fees: Credit cards: 3% plus $0.50 ($1.50 min)
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eChecks: $0.49
Update name from Parent/Guardian 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:
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Parent/Guardian Information
Cardholder's Name:
Billing ZIP/Postal Code:
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