2017-2018 ACTIVITY FEE/CLUB FEE Please complete the following form and return with student activity fee/club fee payment. Only ONE FORM PER FAMILY is necessary. List the names of ALL students in the family who will be participating in the activity or club. Payment can be made IN PERSON at the Athletic Office or MAILED to the Athletic Office at the address below. Please feel free to contact the Athletic Office with questions at 610-582-6100, ext. 1105 or check the website at www.dboone.org Make checks payable to Daniel Boone Area School District. Please return to: DANIEL BOONE HIGH SCHOOL 501 Chestnut Street Birdsboro, PA 19508 Attn: Athletic Department Pay Fees:

High School

Middle School

First Sport

$100.00

$80.00

Second Sport

$ 75.00

$50.00

Third Sport

Free

Free

Club Fee

$50 (This is a onetime fee paid for unlimited clubs) FAMILY CAP OF $300.00

Free/Reduced Lunch Program (call or e-mail Athletic Department for verification/reduced price adjustment)

PLEASE PAY ONLY FOR CURRENT SEASON FOR SPORTS Students will be considered ineligible for their activity or sport if the fee is not paid within the designated three week grace period after the official start of the athletic season or activity. Student(s) Last Name Please Print

Student(s) First Name Please Print

Parent’s Name__________________________________________

Grade

Sport/Club

Total Amount Enclosed: $________

Contact Information(phone or e-mail): ________________________________________________________________________ NOTE: I understand that the fee I am paying does not guarantee a specific role or position and does not warrant a refund of the activity fee. In addition, paying the fee does not guarantee playing time or control over any condition of the team or program. I understand that the fee will not be refunded or pro-rated if a student becomes injured or ineligible during the season, when a student is removed from a team for academic or disciplinary reasons. I understand that the fee does not alter the regulations of the Pennsylvania Interscholastic Athletic Association and/or individual team or activity rules.

For Office Use Only Check #/Money Order

Date Paid

Date Entered______________