MOT Charter High School Clubs (Checks made out to MOT Charter,

online payment, or cash for the exact amount) If you need payment
arrangements please call the office:
_____ Science Olympiad (Mondays $130.00, runs through March)

_____ CyberPatriots (Mondays $50.00, runs through

March)
_____ Math League (Wednesday $90.00, runs through May)
$50.00, runs through

_____ Mock Trial (Wednesdays, beginning in OctoberFebruary)

_____ Art Club ($50.00/semester, runs through May)

_____ Yoga (Wednesdays $25.00, runs through January)

_____ TSA (Wednesdays $50.00/semester, does not include national competition cost)
____ Rock Band (Thursdays $50.00/semester,
runs through May)

Registration fee
per child is due
with
registration on
or before Friday

MOT Charter High School

Please place an X next to each club that you are registering for.
Complete the payment/registration information and send this form
back to the high school office by

Friday, September
11, 2015
_____ Drama/Theater Club (Thursdays

_____ Yearbook (Wednesdays $50.00/semester, runs through May)

$50.00/semester, runs through May)

____ Odyssey of the Mind ($130.00, meeting date varies by advisor)

____FFA (Thursdays, beginning in October, $50.00/semester,

(does not include national competition cost,)

____ Envirothon (Mondays, beginning in November, $50.00, runs through May) _____ National History Competition (Wednesdays
$50.00, runs through April)
_____ BPA (Thursdays $50.00/semester, does not include national competition cost)
________________________________________________________

Student Name
_______________________________________________________________
Email Address
_______________________________________________________________
Phone

I give permission for ____________________________to participate in the _____________________________ club at

MOT Charter High School. I understand and accept the risk involved in such participation and agree to hold MOT Charter
High School, and its employees and agents, harmless for any accidents or injuries sustained by
_________________________________ while participating in the _________________________ club.

________________________________________
Parent Signature

___________________
Date

I will provide a ride for my child at 3:30 PM or the end of the club meeting. I
understand that students may not be on campus unsupervised.
________________________________________
Parent Signature

___________________
Date

** Please Circle Applicable Payment **

Check Enclosed

Office Use Only:

Cash Enclosed

Date Received________

Payment Made Online

Balance Paid in Business Office

Amount Received _________

Check(s) _________