Instructions: Print this fee statment. Send it along with your check, student contracts, & medical forms to the address at the bottom of this form. Make a copy of all forms for your records.

ACDA Honor Groups
Registration Fees





ID Name Group Instrument/Voice Registration Fee
      Total: $0.00
      Total Amount Due: $0.00

Check List

______ ONE check for total amount due
______ This Fee Statement
______ Student Contracts
______ Emergency Medical Treatment Forms

Collect All Fees and Forms from students and send ONE check for the total amount due drawn from your school accounts. Do not send purchase orders. DO NOT STAPLE THE FORMS TOGETHER. SUBMIT SINGLE SIDED COPIES ONLY. Make the check payable to:

ACDA Middle School Honor Choir
c/o Melody Potratz
River City Middle School
1505 N Fir
Post Falls, ID 83854


School officials support the participation of these students and certify that they meet eligibility and participation policies.

Music Teacher Signature:____________________________________ Date _______________________

School Principal Signature ___________________________________ Date _______________________


Refunds of All-State Registration Fees will be paid on the following schedule if the student cannot be replaced:
During December, after registration fees have been paid, $110.00.
After January 1st, $65.00.
No refunds after January 15th.

Postmark deadline - December 4, 2017
Late Fee Enforced if not postmarked by the due date.
Music will be mailed/emailed after December 7, 2017 when the student's fee is paid and all forms have been received.

For Office Use Only
Date Received: _________________________ Check Date: _____________________________
Check #: ______________________________ Amount Received: _________________________
Type of Check: ______________________________