Parent Payment Form

PARENT PAYMENT FORM
The option of paying on-line includes a convenience fee added to your total payment amount to cover card processing fees. Thank you for your understanding.
Parent Information
Parent/Guardian Name *

First Name Last Name
Email Address *
example@example.com
Phone Number
Student Information
Student Name *

First Name Last Name
Select Campus *
Payment Disbursements
Please enter the amounts that you’d like to apply to each category.

Payments *

Tuition $ 1.00

Enter Amount ($)

Daycare $ 1.00

Enter Amount ($)

Technology Enhancement Fee ($50.00) $ 50.00

Elementary Snack Card - $15 (20 snacks) per card $ 15.00

Quantity of Cards

Elementary Lunch Tickets - $12.50 (5 lunches) per strip $ 12.50

Quantity of Ticket Strips

Candy Sale In-lieu Payment - $30 per case $ 30.00

Quantity of Cases

Other (Please specify details at the bottom of the Form) $ 1.00

Amount ($)

Subtotal $ 0.00 Tax $ 0.00 Shipping $ 0.00 Total $ 0.00

PARENT PAYMENT FORM