Form – Mesa Registration Fees

Scholar Name*

First Last

Donor Name*

First Last

Donor's Email*

Donor's Phone #*

Donor's Address*

Street Address Address Line 2 City State ZIP Code

Note: Yearbook and PTO Dues below are not eligible for ECA Donations.

PTO Dues (Per Year)

Price: $20.00 Quantity:

Yearbook Price Until 1-1-19

Price: $35.00 Quantity:

PTO Premium Level Membership

Price: $60.00 Quantity:

For families able to contribute more

Yearbook Quarter Page Senior Ad (**Available Until 02/01**)

Price: $25.00 Quantity:

PTO Gold Level Membership

Price: $120.00 Quantity:

PTO will create and install a 4" x 8" engraved paver brick for GOLD members

Yearbook Half Page Senior Ad (**Available Until 02/01**)

Price: $50.00 Quantity:

PTO Platinum Level Membership

Price: $250.00 Quantity:

PTO will create and install an 8" x 8" engraved paver brick for PLATINUM members

Yearbook Full Page Senior Ad (**Only Available At Registration**)

Price: $100.00 Quantity:

PSAT Test Fee

Price: $20.00 Quantity:

PSAT Prep Seminar(s) Total

Please enter total amount into the field above. Scholar can take 1 - 3 test prep classes available.

Tackle Football (Per season-High School Only)

Price: $400.00 Quantity:

Summer Boys Basketball Camp

Price: $70.00 Quantity:

Fall Semester Sports (Sr. & Jr. High Flag Football, Sr. High Boys Soccer, Jr. & Sr. High Girl's Volleyball, Jr. & Sr. High Cross Country)

Price: $160.00 Quantity:

Summer Boys Jr. High Volleyball Camp

Price: $70.00 Quantity:

Winter Sports (Jr. & Sr. High Boy's Basketball, Jr. High Girl's Softball, Sr. High Girl's Basketball)

Price: $320.00 Quantity:

Summer Conditioning and Training Camp

Price: $70.00 Quantity:

Spring Semester Sports (Jr. & Sr. High Boy's Volleyball, Jr. High & Sr. High Boy's Baseball, Jr. & Sr. High Co-ed Soccer, Jr. High Girl's Basketball, Sr. High Girl's Softball, Jr. High & Sr. High Track & Field)

Price: $160.00 Quantity:

Summer Flag Football Camp

Price: $150.00 Quantity:

Weight Training Class Fee (Per Semester) (8th grade & Sr. High)

Price: $100.00 Quantity:

Summer Girls Basketball Camp

Price: $70.00 Quantity:

Senior Art - Supplies (Per semester)

Price: $15.00 Quantity:

Summer Girls Jr. High Volleyball Camp

Price: $70.00 Quantity:

Stagecraft - Supplies (Per semester)

Price: $25.00 Quantity:

Summer High School Tackle Football Camp

Price: $200.00 Quantity:

Jr. High Advanced Drama (No fee for Jr. Drama)

Price: $25.00 Quantity:

Summer Soccer Camp June 18-21

Price: $70.00 Quantity:

High School Drama 2 (No fee for Drama 1)

Price: $25.00 Quantity:

Summer Soccer Camp June 11-14

Price: $70.00 Quantity:

High School Honors Drama

Price: $25.00 Quantity:

Summer Swim Camp

Price: $70.00 Quantity:

Dance Class 1,2,3 (Per Semester)

Price: $25.00 Quantity:

Swimming Fee *Competition Only (First Semester Only)

Price: $100.00 Quantity:

Dance Class 4 (Company) Per Semester

Price: $35.00 Quantity:

Swimming Class Fee (Per semester)

Price: $100.00 Quantity:

Ballroom Dance 3 (Team) *No fee for Ballroom 1 & 2

Price: $25.00 Quantity:

Swim Class & Competition

Price: $160.00 Quantity:

Other Payment (Enter Any Quantity)

Did you apply a payment for "other?" If so, please leave a short memo for what your payment is going towards.*

Other Payment Memo*

Do you want to apply this payment to your ECA tax credit?*

Note: Field Trips, Tours and class fees are ECA eligible. PTO Dues, yearbooks, play tickets, concert tickets, uniforms, etc. are NOT eligible for ECA.

Trips & Tours

Note: The fields below are donations fields, if you do not wish to donate you can leave them blank.

Independence/Liberty Tour

Science Tour

Jr. History Tour

Fine Arts Retreat

Dance Department Tour

Music Department Trip

Refund Policy*

I agree that if my student withdraws prior to the first game, one half of the participation fee will be refunded.* However, athletes who quit or are injured after the first game, or are dismissed for disciplinary reasons at any time will have no portion of the participation fee refunded. There will also be no refunds after the first 3 weeks of classes..

Total

$0.00

Name

This field is for validation purposes and should be left unchanged.