Student Registration Secure Payments

Step 2: Secure Credit Card Payments for Student Pharmacy Registration Fees

PLEASE NOTE: Keystone Pharmacy does not fill Inhalers, EpiPens, Injectables, Growth Hormones, Birth Control Prescriptions, or Acne Meds topicals and gels.

Do not proceed if you only need the above services, as we cannot fill these requests. Parent will be contacted if keystone is unable to fill medication.

Please Select # of Students Registered(Required)

The registration fee is $75 per student + a 4% credit card fee.

Please Confirm/List Student Name(s)(Required)

Please list FULL names separated by commas so we can associate your payment with your student(s)

Total

includes 4% credit card fee

Billing Information

Billing / Cardholder Name(Required)

First Last

Billing Email Address(Required)

Enter Email Confirm Email

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payment Information (Secure Checkout)

Please enter your Credit Card below into our Secure form:

Credit Card(Required)

Cardholder Name

Card Details

Please only click the submit button once and wait for the payment to process.