Band Fundraising Buyout Form - Plainfield Central High School Band

This form recognizes a family’s intent to buyout from all fundraising requests from the PCHS Band Boosters. Should all the payments not be made, the family will be asked to begin fundraising again to finish meeting their $550 fundraising goal.

"*" indicates required fields

Student Information

Student Name*

Student First Student Last

Year in School for 22-23 (fall)*

Student's School Email Address (@psd202.org)*

Student Email Confirm Email

Please sign up for this mailing list so that you receive emails from the directors with important information pertaining to band events and commitments.

Join the PCHS Band Email List

Parent/Guardian Information

Primary Parent/Guardian Name*

Primary P/G First Name Primary P/G Last Name

Primary Parent/Guardian Email Address*

Primary P/G Email Confirm Email

Please sign up for this mailing list so that you receive emails from the directors with important information pertaining to band events and commitments.

Join the PCHS Band Email List

Primary Parent/Guardian Cell Phone Number*

Second Parent/Guardian Name

Second P/G First Name Second P/G Last Name

Second Parent/Guardian Email Address

Second P/G Email Confirm Email

Please sign up for this mailing list so that you receive emails from the directors with important information pertaining to band events and commitments.

Join the PCHS Band Email List

Second Parent/Guardian Cell Phone Number

Fundraising Buyout Information

If you select to make payments via credit card, you agree to transactions on the following schedule:

One CC Payment – Today
Two CC Payments – Today and February 1
Five CC Payments – Today and the 1st day of December, January, February, and March

If you select to pay by check, payments are expected on the following schedule:

One Payment – by November 1
Two CC Payments – by November 1 and February 1
Five CC Payments – by November 1 and the 1st day of December, January (or returning to school), February, and March

Fundraising Buyout Selection*

Payment

Credit Card Transaction Fee

Price: $0.00

Total

This is the combined total of your first (or full) buyout payment plus the transaction fee that is paid to the processor to charge your card.

Payment Information

Your payment will be processed securely via Square!

Cardholder Name

Card Details