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EAGLE CLUB REIMBURSEMT REQUEST FORM
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***THIS FORM IS VIEW ONLY. MAKE A COPY AND SAVE THIS FORM TO COMPLETE IT ELECTRONICALLY***
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For reimbursements or vendor payments, you must attach a receipt or invoice. Taxes will not be reimbursed. Please use tax-exempt letter on the Eagle Club website. Processing of all fund requests MAY take up to 30 days.
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TODAY'S DATE:10/8/2026
CLUB/SPORT NAME:
Men's Soccer
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PURPOSE OF REQUEST:
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Reimbursement to Parent/Staff
Cash Box for Event
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Payment to Vendor for Goods or Services
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AMOUNT OF REQUEST:$249.92
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PAYEE NAME:Kyrsten Haas
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PAYEE ADDRESS:12409 Carter Lane, Kearney, MO 64060
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DETAILED Teacher Appreciation Night gift reimbursements
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DESCRIPTION OF
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REQUEST:
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DELIVERY METHOD:x
Mail to Payee at Address Above
Leave Check in EC Mailbox
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FOR CASHBOX REQUESTS:
Need by Date (Check will be written to parent rep or coach to cash)
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By submitting this form to the EC Treasurer, the Parent Rep acknowledges that they approve this request. To obtain Coach/Sponsor approval, they must either physically sign and scan the form submitted, or you may copy them on the email to the EC Treasurer and indicate "COACH APPROVAL NEEDED" so they may respond to the email. Any request may take up to 30 days to process. Any exceptions to this will be limited and must be requested to the Eagle Club President.
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Parent Rep Name:Kyrsten Haas
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Parent Rep Email:kyrstieharp@yahoo.com
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Parent Rep Phone:
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Coach Name:Art Smith
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Coach Email:art.smith@lps53.org
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Coach Phone:816-522-9808
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EAGLE CLUB USE ONLY:
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Date Paid:Date Recorded:
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Check Number:
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Comments:
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Treasurer Name:
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SUBMIT THIS FORM AND SUPPORTING DOCUMENTS ELECTRONICALLY TO TREASURER@LNHSEAGLECLUB.COM
AND COPY YOUR COACH OR SPONSOR.
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