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Extended Day Payment

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  Student Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Parent Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent Email REQUIRED Please fill out this field. Please enter an email address.
  
  Parent Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Payment Amount REQUIRED $ Please fill out this field. Please enter a positive decimal.
  
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