Hawthorn Academy South Jordan

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Club and Sports Fees

Student's Full Name

Clubs

4th Grade Ballroom:

$70.00

Quantity:

Item Subtotal:

$0.00

5th and 6th Grade Ballroom:

$150.00

Quantity:

Item Subtotal:

$0.00

Art Club:

$10.00

Quantity:

Item Subtotal:

$0.00

Board Game Club:

$10.00

Quantity:

Item Subtotal:

$0.00

Chess:

$10.00

Quantity:

Item Subtotal:

$0.00

Choir:

$25.00

Quantity:

Item Subtotal:

$0.00

Coding Club:

$20.00

Quantity:

Item Subtotal:

$0.00

Elementary Band:

$50.00

Quantity:

Item Subtotal:

$0.00

Total:

$0.00

Parent/Guardian Info

First Name:		Last Name:
Phone:
Email:

Payment Information:

Processing Fee Rates:
Cards:	3% plus $0.50 ($1.50 min) (1.5% surcharge for foreign cards)
eCheck:	$0.50

Method of Payment:
Update Name from Personal/Organizational Information

Name on Account:
Routing Number:
Account Number:
Institution:

Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:

Change Payment Method

Your statement will describe your payment as

‘CBT*HAWTHORN ACADEMY’ and the service fee transaction as ‘CBT*SVC FEE HAWTHORN’

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