Request For Athletic Fee Payment Plan/reduction/waiver Form printable pdf download

Everett Public School

REQUEST FOR ATHLETIC FEE PAYMENT PLAN/REDUCTION/WAIVER

In order to maintain current athletic programs, the Everett Public Schools charges a $100 fee per sport to offset

the costs of transportation and coaching stipends. Some families have financial hardships that do not allow

them to pay the full fee up front or at all. Everett Public Schools is willing to work with families to ensure all

students have the opportunity to participate if they wish.

To request a payment plan, reduction or waiver of the athletic fee, complete this form and return it to your

school’s athletic director. To be eligible to compete, students must either pay the fee or have a plan to take care

of the fee on file with the office prior to the first contest of the season.

Student:____________________________

Parent/Guardian:__________________________

Sport:______________________________ Daytime Phone:___________________________

Date of last regular season contest:__________

Do you qualify for Free or Reduced Lunch?

Yes No

Do you participate in other sports? Yes

If yes, which sports_________________________

Do you have any other children participating in sports at a middle school or high school in Everett Public

Schools?

Yes

(If yes, please list the student, school, and sport(s) below)

Student:____________________School:____________________Sport_______________

Request:

The final payment must be made before the last

Payment plan: Complete the plan below.

regular season contest, listed above. If a payment is missed, participation in the sport will be

suspended until the payment is made.

Amount:_________Date:__________

Partial Fee Reduction: Please include an explanation why on back. Amount:__________

Full Waiver: Please include an explanation why on back.

Student Signature:______________________________________ Date:__________

Parent/Guardian Signature:________________________________ Date:__________

To be completed by the Treasurer

Does the student have any outstanding fines?

(If yes, please list amount_________)

Has the student purchased an ASB card?

To be completed by the Athletic Director

Approval:

Yes

Signature:_______________________________________

Request For Athletic Fee Payment Plan/reduction/waiver Form