Eau Claire Area High School Athletic Fee Collection Form
School:
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North High School
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Memorial High School
Athlete’s Last Name:_________________________ First Name:_______________ Grade: _____ Sport:_______________
Athlete’s Last Name:_________________________ First Name:_______________ Grade: _____ Sport:_______________
Athlete’s Last Name:_________________________ First Name:_______________ Grade: _____ Sport:_______________
Parent/Guardian Last Name:_______________________________________ First Name: ____________________________
Mailing Address:____________________________________________________ Phone: ____________________________
 Make check payable to ECASD (Eau Claire Area School District), and mail/return form and payment to:
Attn: Lindsey, 500 Main Street, Eau Claire, WI 54701. Your check will serve as your receipt.
 Any questions regarding fees can be directed to Lindsey at 715-852-3016 or [email protected].
Please check boxes for which payment is included:
Fall High School Sports
Winter High School Sports
Spring High School Sports
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Cheer/Spiritline ....................... $100
Cross Country—Men .............. $100
Cross Country—Women ......... $100
Football ................................... $200
Golf—Women ......................... $200
Soccer—Men .......................... $200
Swim & Dive—Women............ $200
Tennis—Women ..................... $200
Volleyball ................................. $200
Basketball—Men..................... $200
Basketball—Women ............... $200
Cheer/Spiritline ....................... $100
Dance ..................................... $200
Gymnastics ............................. $300
Hockey—Men ......................... $300
Hockey-Women ...................... $300
Swim & Dive—Men ................. $200
Wrestling ................................. $200
Baseball ................................... $200
Golf—Men ............................... $200
Softball ..................................... $200
Soccer—Women ..................... $200
Tennis—Men ........................... $200
Track—Men ............................. $100
Track—Women........................ $100
Participation fees will not be prorated/
reimbursed for shortened seasons
National School Lunch Consent
The information you supplied on your Free and Reduced School Meals Application will not be shared with other programs for
which your children may qualify without your consent. We must have your permission to share this information for the discount
on your participation fees.
YES! I give permission to use the NSL free and reduced information to receive the discount for Eau Claire Area
School
Athletic Fee Reimbursement:
Check if applicable:
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Individual Cap: Pay for 2 sports
Family Cap: $800 per year maximum or $400 if paying reduced fees
Qualify for half price participation fee (receive reduced priced lunch)
Qualify for free participation (receive free lunch)
The athletic fee will be reimbursed if the athlete is not
part of the team on:
 September 15, 2017 for Fall
 December 15, 2017 for Winter
 April 13, 2018 for Spring
You will be reimbursed via mail within two weeks of these dates.
This form must be completed, SIGNED, and submitted to the ECASD Accounting Office prior to student participation
Signature of Parent/Guardian: ___________________________________________________
Total Payment: ___________________
Office
Use
Only
Date Paid:________________________________
Date:____________________
Paid by:
Amount:_____________________
 Cash  Check
If applicable, check
In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national
origin, sex, age, or disability. To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington,
D.C. 20250-9410 or call (800) 795-3272 or (202) 720-6382 (TTY). USDA is an equal opportunity provider and employer.
05/02/17