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Student Information
Student Name
*
First Name
Last Name
Grade
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Parent/Guardian Information
Parent / Guardian Name
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Email Address
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Phone Number
Format: (000) 000-0000.
Payment Disbursements
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Tuition
$1.00
$
1.00
Amount ($)
Registration Fee
$1.00
$
1.00
Amount ($)
Sports Fee
$1.00
$
1.00
Amount ($)
Spirit Pack
$1.00
$
1.00
Amount ($)
Student Activity Fee
$1.00
$
1.00
Amount ($)
Books
$1.00
$
1.00
Amount ($)
Other
$1.00
$
1.00
Amount ($)
Subtotal
$0.00
$
0.00
Tax
$0.00
$
0.00
Shipping
$0.00
$
0.00
Total
$0.00
$
0.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
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Expiration Month
Expiration Year
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Comment
Signature
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Calvary Baptist Church And School | 2990 Damien Ave, La Verne, CA 91750 | 909-593-4672
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