5th Grade Activity Form Fee

PLEASE FILL OUT ONE FORM PER FAMILY. The Activity Fee is $55 per student and helps to cover various 5th grade level activities.

"*" indicates required fields

STUDENT INFORMATION

How many 5th grade child(ren) attend Selwyn?*

Student #1 Name*

First Last

Student #1 Teacher*

Student #2 Name*

First Last

Student #2 Teacher*

Student #3 Name*

First Last

Student #3 Teacher*

PARENT/GUARDIAN COMMUNICATION INFORMATION

Please provide the email address you would like to use to receive information from the Fifth Grade Events team.

Parent/Guardian Name(s)*

First Last

Parent/Guardian Email*

Phone*

(Please use this format XXX-XXX-XXXX)

Additional Parent/Guardian Name

First Last

Additional Parent/Guardian Email

Additional Phone

(Please use this format XXX-XXX-XXXX)

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Yard Sign

Check if you would like to purchase a yard sign. The cost is $15 and distribution will be communicated separately.

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How many signs would you like to order?

Scholarship

5th Grade Activity Fee Scholarship*

In an effort to provide financial assistance to those families in need, please consider providing a donation to help cover the cost of a student. Any donation amount will be gladly accepted (no amount is too small), and it will be added to your total payment.

SUMMARY

5th Grade Activity Fee (1 student)

Price:

5th Grade Activity Fee (2 students)

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5th Grade Activity Fee (3 students)

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5th Grade Sign (Qty 1)

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5th Grade Sign (Qty 2)

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5th Grade Sign (Qty 3)

Price: