2016-2017 Waddell PTA Membership Application
Applicant Information
PLEASE PRINT CLEARLY
NAME:
󠇨 I am a parent/guardian	󠇨 I am a family member:	PHONE #
EMAIL:
󠇨 Include me in PTA email notifications	󠇨 I do NOT want email notifications
󠇨 I would like to volunteer	󠇨 I can ONLY volunteer from home	󠇨 I am unable to volunteer
Student Information
Child #1 Name:
Teacher:	Grade:
CHILD #2 NAME:
TEACHER:	GRADE:
CHILD #3 NAME:
TEACHER:	GRADE:
PTA ADULT MEMBERSHIP
PAYMENT AMOUNT: 󠇨󠇨 $7.50 (one adult) 󠇨󠇨 Other $__________
󠇨 CASH	󠇨 CHECK (please make checks out to Waddell PTA)
For PTA USE ONLY
󠇨 Data Entered into System
󠇨 Payment Received	Date:
󠇨 Thank You Compiled	󠇨 Thank you delivered
󠇨 Membership Info Delivered
Signatures
I authorize the application of my 2016-2017 PTA Membership.
Signature of applicant:	Date:

Thank You for Becoming a PTA Member! You are an important part of advocating for your child and all children, with ONE VOICE. Your support will bring us one step closer to achieving our goals!

For questions or suggestions, please contact Erica Parent (860)810-5273 or email rickyleemomof3@gmail.com

*Your PTA Membership dues:

$2.25 goes to the National PTA Organization.

$3.25 goes to the Connecticut PTA Organization

$2.00 goes directly towards the Waddell PTA.