Transcript Pleasanton Middle School Parent Faculty Association (PFA

Pleasanton Middle School Parent Faculty Association (PFA)
Working to benefit the entire student & teacher community of PMS
Membership & Voluntary Donation Form
PFA Membership
Cashier Initials/Payment Type
_____ PMS PFA Membership - $25 Includes Directory and Newsletter
Choose one: _____ an electronic directory
_____a hard copy directory
$_____________
__________
PERMISSION
Directories are only provided to PFA family and faculty members. We must have your permission to include you in the directory. Please mark ONE of the two boxes below.
_____Yes, please include the information below in the directory.
______No, please DO NOT include the information below in the directory.
I acknowledge the directory information below is accurate. I understand that the directory is published expressly for the personal use of Pleasanton Middle School PFA Community. Initials:
Voluntary Donation
_____ PMS PFA Donation – suggested donation $200 per student (any amount is greatly appreciated and will be used to benefit all PMS students)
$______________
__________
_________________________________________________________________________________________________________________________________________________________________________________________________________
_
DIRECTORY INFORMATION (please PRINT clearly)
____Our child / children were in last year’s directory
STUDENT INFORMATION
Student Last Name
Student First Name
Grade
1.___________________________________
__________________________________
_____
(_____) ______ ‐ ______
2.___________________________________
__________________________________
_____
(_____) ______ ‐ ______
3.___________________________________
__________________________________
_____
(_____) ______ ‐ ______
PARENT/GUARDIAN INFORMATION
Home Phone
Last Name (Household #1)
Mother First Name
Father First Name
Cell phone with carrier
___________________________
_________________________
_____________________
__________________________
Home Address (address, city, zip code)
E-mail address
____________________________________________
_________________________________________________________
Last Name (Household #2)
Mother First Name
_____________________________ _________________________
Father First Name
Cell phone with carrier
______________________
____________________________
Home Address (address, city, zip code)
E-mail address
_______________________________________________
___________________________________________________________