7th Grade Trip

Philadelphia Trip

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Student Name*

First Last

Parent Name

Parent Email*

Consent*

I allow my daughter to attend the 7th grade Philadelphia Trip.

Trip Fee:

Price:

Payment*

I will pay by credit card with an additional processing fee of $3.

I will send cash\check of $100 to Miss. Werner

Processing Fee

Price:

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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