Roosevelt Junior High School
             
Roosevelt Junior High School Registration and Fees

Student Name and IDLastname,Firstname-ID#
 
Yearbook (Optional)
Yearbook (Optional):   $40.00   Select:   Item Subtotal:  
$0.00
 
7th Grade Fees
7th Grade Activities/Locker/Books (Required):   $75.00   Select:   Item Subtotal:  
$0.00

8th Grade Fees
8th Grade Activities/Locker/Books (Required):   $75.00   Select:   Item Subtotal:  
$0.00
 
Other
Other:   $   Item Subtotal:  
$0.00
Please describe the purpose of the additional payment. [1]

Please describe the purpose of the additional payment.

[2]

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[3]

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[4]

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[5]

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[6]

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[7]

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[8]

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[9]

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[10]
 
Total:
$0.00
 
Parent/Guardian Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
Payment Information
Method of Payment:
Processing Fees: Credit cards: 3% plus $0.50 ($1.50 min)
                    (4.50% processing fee for foreign cards)
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:
Confirm 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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