Child's Name (required)

Room Number
Room 1Room 2Room 3Room 4Room 5Room 6Room 7Room 8Room 9Room 10Room 11Room 12Room 13Room 14Room 15Room 16Room 17Room 18

Donation:
Family (2 or more children)Single Child

Donation amount:
Family $250.00 per annumFamily $62.50 per termSingle Child $150.00 per annumSingle Child $37.50 per termOther amount (Please specifiy).......

Paper / ICT Levy:
$25.00 per student

Tech Fees - Year 7 and 8:
$75.00 per annum

Please indicate how payment is to be made::
CashChequeInternet Banking
Total of Payment:

Date payment is made: