Form - Mesa Registration Fees | Heritage Academy Gateway

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 Family Per Year)

Price: $20.00 Quantity:

Yearbook (until 01-01-20)

Price: $30.00 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:

Dimensions: W:3 9/16" H:4 13/16"

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:

Dimensions: W: 7.5" H:4 13/16"

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 (**Available Until 02/01**)

Price: $100.00 Quantity:

Dimensions: W:7.5" H:10"

Tackle Football (Per season-High School Only)

Price: $400.00 Quantity:

Summer Boys Sr. High Basketball Camp July 8, 11, 12

Price: $50.00 Quantity:

$50 for all 3 days or $20 per day

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 Sr. High Volleyball Camp July9,10,11,16,17,18

Price: $145.00 Quantity:

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

Price: $160.00 Quantity:

Summer Flag Football Camp

Price: $150.00 Quantity:

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

Price: $160.00 Quantity:

Summer Girls Jr. High Volleyball Camp July 9, 10, 15, 16

Price: $70.00 Quantity:

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

Price: $25.00 Quantity:

Summer Girls Sr. High Volleyball Camp July 9, 10, 11, 16, 17, 18

Price: $195.00 Quantity:

Senior Art - Supplies (Per semester)

Price: $15.00 Quantity:

Summer High School Tackle Football Camp

Price: $200.00 Quantity:

Stagecraft - Supplies (Per semester)

Price: $25.00 Quantity:

Summer Swim Camp July 10, 11, 15, 16

Price: $70.00 Quantity:

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

Price: $25.00 Quantity:

Dance Class 1,2,3 (Per Semester)

Price: $25.00 Quantity:

High School Drama 2 (Per Semester) No fee for Drama 1

Price: $25.00 Quantity:

Dance Class 4 (Company) Per Semester

Price: $35.00 Quantity:

High School Honors Drama (Per Semester)

Price: $25.00 Quantity:

Swimming Fee *Competition Only (First Semester Only)

Price: $100.00 Quantity:

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

Price: $25.00 Quantity:

Swimming Class Fee (Per semester)

Price: $100.00 Quantity:

Wrestling Class

Price: $160.00 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 & Drama Disney Tour

Music Department Trip

France Tour

Puerto Rico Excursion

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

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Name

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