Fillable Printable Family Allowance Form Sample

Family Allowance Form Sample

7020F

Revised: 4/2013

Expenditure Choices:

First Tier

$0.00

Communication: Internet Services up to $300 : Complete

Form

On-Line Curriculum: Odysseyware ($250 per class or apply

the total allowance per child for complete offerings

Traditional Curriculum: Complete Form

Second Tier

$0.00

Individual Lessons or Tutoring: Music/Dance/Language

(aprox. $15/30 min. lesson or $20 per hr. tutoring)

Classes or Teams: Swim/Dance/Gymnastics (per request)

Technology Equipment: IPod/IPad/Kindle/Nook

Usage Fees: Computer ($50)/ Technology ($25)/

Replacements/ Repairs

Third Tier

$0.00

Swim Passes: in Hayward at $30 for 6 punches

Memberships: Science Museum/YMCA/etc.

Instrument Rental

OTHER: Upon Request

Allowance Total

$0.00

Tier Totals

$0.00

Remainder

$0.00

FAMILY ALLOWANCE FORM

2013-2014

Family Name: _____________________________________

ALLOWANCE CALCULATOR

Students

Allowance

Totals

Grades K-4:

$800

Grades 5-8:

$900

Grades 9-12:

$1,000

ALLOWANCE TOTAL

$0.00