Form – Mesa Registration Fees

Scholar Name*

First Last

Donor Name*

First Last

Payee 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.

Yearbook

Price: $50.00 Quantity:

Full Page Senior Ad in Yearbook

Price: $100.00 Quantity:

PTO Dues (Per Year)

Price: $20.00 Quantity:

Senior Art - Supplies (Per semester)

Price: $15.00 Quantity:

Digital Photography - Supplies (Per semester)

Price: $15.00 Quantity:

Piano Class- Supplies (Per semester)

Price: $25.00 Quantity:

Tennis Class - Court fee (Per semester)

Price: $75.00 Quantity:

Golf Class - Greens fee (Per semester)

Price: $100.00 Quantity:

Bowling - Alley fee (Per semester)

Price: $110.00 Quantity:

Club Fitness - Class fee (Per semester)

Price: $30.00 Quantity:

Fall Semester Sports (Volleyball, Basketball, Cross-Country, Flag Football)

Price: $150.00 Quantity:

Spring Semester Sports (Basketball, Soccer, Softball, Baseball)

Price: $150.00 Quantity:

Swimming Fee (Per semester)

Price: $175.00 Quantity:

Tackle Football (Per season-High School Only)

Price: $400.00 Quantity:

Boys' Volleyball (Spring Season-High School Only)

Price: $150.00 Quantity:

Boys' Volleyball (Spring-If 3rd Sport)

Price: $75.00 Quantity:

Jr High Girls' Softball (Per Season-Spring & Fall)

Price: $150.00 Quantity:

Jr High Girls' Softball (Spring & Fall-If 3rd Sport)

Price: $75.00 Quantity:

Dance Class (Per Semester)

Price: $25.00 Quantity:

Ballet (Per Semester)

Price: $25.00 Quantity:

Summer High School Tackle Football Camp

Price: $200.00 Quantity:

Summer Flag Football Camp

Price: $175.00 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 and Tours and class fees are ECA eligible, but 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

Music Department Trip

Arts Retreat - Jan 2018

Dance Company Tour

Total

$0.00

Phone

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