Imagine Prep @ Surprise

Athletic Payment Plan

Student Athletes Name:_______________________________
Season (circle one):

Fall

Winter

Spring

Sport: _____________________________
PAYMENT PLAN ARRANGEMENTS
Amount Due: __________________
NOTE: Amount due must be paid in full before ______________ or player will not be allowed to
participate in the sport. In addition, any monies paid up to the cutoff date will NOT be refunded
even if child is barred from participation due to full payment not being timely received or other
penalties outlined in the Policy.
Payment Plan Details:
Parent/Guardian volunteer agreement:
I understand that the Athletics Fee is not waive-able and must be paid in full. I also understand that failure
to pay the fee, or follow the agreed payment plan, will result in certain privileges being withheld until the
required payments are received. These privileges include, but are not limited to, further participation in
athletics as well other extracurricular activities at Imagine Prep Surprise.
All information on this form is accurate to the best of my knowledge. I fully agree to the payment terms
listed above and understand that if I do not communicate any necessary changes to the plan for fail to
follow through with my commitment as outlined above, our family/my child will be subject to the rules
outlined in the Policy.
*ALL INFORMATION ON THIS FORM WILL BE KEPT STRICTLY CONFIDENTIAL.*
I agree to the following payment plan:
A sum of $ _____
On a (circle one)

Weekly
(Minimum $15)
_____________

Bi-weekly
(Minimum $35)
_____________

First payment to be received on ________________________

(Day and Date)

Monthly
(Minimum $50)
______________

Required Signatures
_________________________________ Date: ____________
(Parent/Guardian)

_________________________________ Date: ____________

(Athletic Director)

Athletic Department Use Only:

Date Received: ________________________
Request Approved: Yes/No
Date of completion: ___________________
Athletic Director Signature: __________________

Notes
Checks made payable to Imagine Prep Surprise.
Contact Mr. Sachau if this plan will not be a suitable solution for your needs.
Sean .Sachau@sp.imagineprep.com