Potential Student Activity Fee

Activity Fee Structure

Standard Rate:
Base Fee: $25 per student
Additional Fee: $25 per extracurricular activity or sport

Reduced Lunch Program
Base Fee: $10 per student
Additional Fee: $10 per extracurricular activity or sport

Free Lunch Program
No activity fees required

Payment and Admission
Once the activity fee is paid, a sticker will be issued and placed on the student’s school ID. This sticker grants the student admission to various school events throughout the year.

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Email Address*

example@example.com

Student 1*

	First Name	Last Name	Grade
Student 1

Student 1 - Number

Student 1 - Jr. High Activities

	Fall Sport/Activity	Winter Sport/Activity	Spring Sport/Activity
Student 1

Student 1 - High School Activities

	Fall Sport/Activity	Winter Sport/Activity	Spring Sport/Activity
Student 1

Student 2

	First Name	Last Name	Grade
Student 2

Student 2 - Jr. High Activities

	Fall Sport/Activity	Winter Sport/Activity	Spring Sport/Activity
Student 2

Student 2 - High School Activities

	Fall Sport/Activity	Winter Sport/Activity	Spring Sport/Activity
Student 2

Student 2 - Number

Student 3

	First Name	Last Name	Grade
Student 3

Student 3 - Jr. High Activities

	Fall Sport/Activity	Winter Sport/Activity	Spring Sport/Activity
Student 3

Student 3 - High School Activities

	Fall Sport/Activity	Winter Sport/Activity	Spring Sport/Activity
Student 3

Student 3 - Number

Total Number of Activities

Select your Corresponding Fee:*

Base Fee

$25.00 Number of StudentsLunch Status

Sport/Activity Fee

$25.00 Number of Total ActivitiesLunch Status

Total

$0.00

Payment Information
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signature*

Student Activity Fee Payment Form