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Pleasanton Middle School Parent Faculty Association (PFA) Working to benefit the parents, students and staff at PMS Membership & Voluntary Donation Form. PFA Membership Cashier Initials/Payment Type
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Pleasanton Middle School Parent Faculty Association (PFA) Working to benefit the parents, students and staff at PMSMembership & Voluntary Donation Form PFA Membership Cashier Initials/Payment Type _____ PMS PFA Membership - $25 ( Includes Directory) Choose one:_____ an electronic directory _____a hard copy directory $_________ __________ PERMISSIONDirectories 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) STUDENT INFORMATIONStudent Last Name Student First Name Grade Home Phone1.___________________________________ __________________________________ _____ (_____) ______ ‐ ______ 2.___________________________________ __________________________________ _____ (_____) ______ ‐ ______ 3.___________________________________ __________________________________ _____ (_____) ______ ‐ ______ PARENT/GUARDIAN INFORMATION Father First Name Mother First Name Last Name ___________________________ _________________________ _____________________ Home Address (address, city, zip code) ________________________________________________________________________________________________________________ Home Phone Number Cell Phone Number ___________________________________ ______________________________________________________________ E-mail address ________________________________________________________________________________________________