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Club Payments
Chris Brush
2026-07-13T12:39:56-04:00
Club Payments
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How many payments are you making at this time?
*
--- Select Choice ---
1
2
3
4
This form can be used for multiple Students or Payments. For multiple payments for the same student repeat the student name in each Name Field.
Payment 1
Student Name (1)
*
First
Last
Club (1)
*
--- Select Choice ---
Book Club
Book Chat
Book Talk
Math Team
Payment Type (1)
*
--- Select Choice ---
Pizza
T Shirt
Other
Other Description
*
Payment Amount (1)
*
Minimum Price: $5.00
Name (2) (4)
Payment 2
Student Name (2)
*
First
Last
Club (2)
*
--- Select Choice ---
Book Club
Book Chat
Book Talk
Math Team
Payment Type (2)
*
--- Select Choice ---
Pizza
T Shirt
Other
Other Description
*
Payment Amount (2)
*
Minimum Price: $5.00
Payment 3
Student Name (3)
*
First
Last
Club (3)
*
--- Select Choice ---
Book Club
Book Chat
Book Talk
Math Team
Payment Type (3)
*
--- Select Choice ---
Pizza
T Shirt
Other
Other Description
*
Payment Amount (3)
*
Minimum Price: $5.00
Payment 4
Student Name (4)
*
First
Last
Club (4)
*
--- Select Choice ---
Book Club
Book Chat
Book Talk
Math Team
Payment Type (4)
*
--- Select Choice ---
Pizza
T Shirt
Other
Other Description
*
Payment Amount (4)
*
Minimum Price: $5.00
Payment Information
Parent Email
*
Total
$0.00
Credit Card
*
Card
Name on Card
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