RIVERSIDE BROOKFIELD HIGH SCHOOL Pay to

RIVERSIDE BROOKFIELD HIGH SCHOOL 2017-18 FALL PAY TO PARTICIPATE ATHLETIC FEE FORM ATHLETIC SEASON It is the responsibility of the student athlete and his/her parent or guardian to complete this form, and unless exempted in accordance with the Athletic Pay to Participate Policy, pay the applicable Pay to Participate fee to the school Business Office on the listed due dates for that specific sport identified on the Riverside Brookfield Athletic website. Fee Structure: $200.00 if this is a student's 1st sport of the 2017-18 school year $150.00 if this is a student's 2nd sport of the 2017-18 school year $100.00 if this is a student's 3rd sport of the 2017-18 school year In accordance with District 208 policy, payment may be made either in full or in two installments. If paying in full, payment is due before the first 2017 Fall athletic contest. If paying in two installments, one-half of the fee is due before the first 2017 Fall athletic contest and one-half is due no later than October 6, 2017. Checks may be made out to Riverside Brookfield High School. Failure to submit payment on the due date(s) will result in the following consequences: 1. Student athletes will not be able to participate in any further athletic contest during the season. 2. Student athletes will not receive any recognition or awards from the season until payments are made in full. 3. Student athletes will not be able to register or tryout for any other sport at Riverside Brookfield until the athletic fee is paid in full. 4. While any Pay to Participate fee is overdue, Seniors will be subject to social restrictions, such as being barred participation in dances, Prom, and the Senior Picnic. 5. Students will incur a $50.00 late fee. Student Name______________________________________________________________________________________ (please print) 2016-17 Fall Sport________________________________________________________________________________ (please print) Please choose from the following payment options: _____ One full payment due before the first athletic contest of the 2017 Fall Season. _____ Two installments- the first payment due before the first athletic contest of the 2017 Fall Season and the second payment due no later than October 6, 2017. Student Signature_________________________________________________________________Date______________ Parent/Guardian Signature__________________________________________________________Date______________ FORM MUST BE RETURNED TO THE BUSINESS OFFICE FOR BUSINESS OFFICE ONLY

_____ Exempt Date: _________

_____ Paid in Full Initials:_________

_____ Installment