Jean Day

Required

***NO DAILY FRIDAY RATES WILL BE ACCEPTED. FULL ANNUAL PACKAGE MUST BE PURCHASED TO PARTICIPATE***

***MUST BE PAID BY THE WEDNESDAY PRIOR TO THE JEAN DAY BEING PAID***

NO CASH WILL BE ACCEPTED

STUDENT NAME: ONE STUDENT INFO PER SUBMISSIONrequired

First Name

Last Name

LOWER SCHOOL GRADE:

MIDDLE/HIGH SCHOOL GRADE:required

ELEMENTARY HOMEROOM TEACHER:required

MIDDLE/HIGH 1ST PERIOD TEACHER:required

MIDDLE/HIGH 2ND PERIOD TEACHER:required

B DAY

PARENT/GUARDIAN EMAIL ADDRESS:required

PARENT/GUARDIAN EMAIL ADDRESS:

PARENT/GUARDIAN PHONE NUMBER:required

PARENT/GUARDIAN PHONE NUMBER:

JEAN DAY FEE

$34.88

Subtotal: $34.00 + 2.5% Convenience Fee

Terms of Servicerequired

I agree to the Terms of Service. No Refunds, transfers or credits. No Exceptions.

Please select a payment typerequired

Credit Card

Billing Addressrequired

Address

City

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Country

Zip/Postal Code

Cardholder Namerequired

First

Last

Expirationrequired

Month

Year

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