EXCURSION PAYMENT FORM FOR
PARENT/GUARDIAN
Name of Student: Year: Yr 9
Maritime Museum Fremantle and Portarosa Italian
Payment for (name of Excursion):
Restaurant
Amount: $40.00
I have enclosed cash
o
r
I have paid via direct deposit to on ______/______/______
Kalamunda Senior High School
BSB: 016-341 ACCT: 427 511 475
(reference: please put child’s name and year i.e. J Citizen Yr 9)
o
r
I have enclosed cheque/money order
o
r
Please debit my credit card (please note: AMEX or DINERS are not accepted)
Mastercard Visa
Card No:
Expiry Date: /
Signature: _____________________________________________________
Name on Card: _________________________________________________