PROGRAM FEE REMITTANCE FORM:

Non-Public Schools ONLY

(for Public Schools, use “Program Fee Remittance Form: Public Schools”)

Site (circle one)

Elms or Sotterley

School

Teacher

Trip Date

Grade

Fee per student

(circle one)

PreK, K, 1, 2, 3, 4 and Grade 7

$10.00

Grade 5

$13.00

High School (@ Elms)

$10.00

High School (@ Sotterley)

$13.00

Overnight

$31.00

Number of Students Attending

Total Amount Due

Amount

Collected from Students

Amount

Covered by School

Complete the above information and send with a check for the total amount payable to:

St. Mary’s County Public Schools  

Forward to Lisa Miller, Department of Fiscal Services

Revised 09/15/16