Activity Fee Letter and Form - Perkiomen Valley School District

Perkiomen Valley School DistrictLearners Today, Leaders Tomorrow2011-2012 Student Activity FeeThe established Student Activity Fee for the 2011-2012 school year is $50 per student in grades 7-12. Thereis a maximum fee of $150 per family. Activities that will be assessed fees include all sports programs (bothinterscholastic and intramural) and non-graded activities such as band, chorus, school plays and musicals,and clubs. To see a list of extra-curricular activities and athletic programs for which the $50 activity fee mustbe paid, please visit http://lsurl.me/15H. Please complete the information below for each student, andindicate a minimum of one activity/sport/club that each child plans to participate in this year.Student Name: ___________________________________________________School: ____________________________Grade: _____________Activity/Sport/Club: ______________________________Student Name: ___________________________________________________School: _____________________________Grade: _____________Activity/Sport/Club: ______________________________Student Name: ___________________________________________________School: _____________________________Grade: _____________Activity/Sport/Club: _____________________________Family Address: _________________________________________________________________________I am submitting payment by:□ Cash □ Money order □ Check # ______ □ I am applying for a waiver (see back of thisform)________________________________________________________________________Signature of Students________________________________ ______________________________________Signature of Parent/GuardianPrinted Name of Parent/GuardianNote: I understand that the fee I am paying does not guarantee a specific role or position in a musical activity or club and thatresigning from an activity or club does not warrant a refund of the activity fee. In addition, paying the fee does not guaranteeplaying time or control over any condition of the team or program. The fee is not refundable once a position on a team issecured or participation in an activity has started. In addition, I understand that the fee will not be refunded or pro-rated if astudent becomes injured or ineligible during the season, when a student is removed from a team for academic or disciplinaryreasons, when cancelled contests cannot be rescheduled, or when a full allotment of games cannot be scheduled. I understandthat paying the fee does not alter the Student Athlete Policies of the Perkiomen Valley School District or the regulations of thePennsylvania Interscholastic Athletic Association and/or individual team or activity rules.InstructionsPlease complete this form, attach your payment (cash, money order, or check payable to PerkiomenValley School District), and return it to your child’s school office or to:Perkiomen Valley School DistrictAttn: Activity Fees3 Iron Bridge DriveCollegeville, PA 19426Write your child(ren)’s name and activity in the memo portion of the check. The deadline for feesubmission for fall activities is Friday, September 16, 2011.Please note: if your child(ren) qualifies for Free or Reduced Lunch, please follow the directions onthe back of this form to apply for a waiver.For Office Use OnlyCheck # _____________ Date Paid _________________ Date Entered ________________