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"
*
" indicates required fields
STUDENT INFORMATION
How many children attend Selwyn?
*
1
2
3
Student #1 Given Name
*
First
Last
Student #1 Teacher
*
K - Derrick
K - Eccles
K - Majithia
K - Maronich
K - Nelson
K - Peterson
1st - Pitts
1st - Thayer
1st - Thompson
1st - Vruwink
1st - Watson
1st - Zielinski
2nd - Blau
2nd - Kepley
2nd - McDonald
2nd - Mills
2nd - Patton
3rd - Bains
3rd - Cooney
3rd - Judd
3rd - Mateer
3rd - Quattropani
4th - Gardepe
4th - Lockwood
4th - Ponder
4th - Postal
5th - Chalfant
5th - Desmond
5th - Mayer
5th - Richardson
Ext (K-2 Dev) - Bayne
Ext - Clark
Ext - Davis
Ext - Eley
Student #2 Given Name
*
First
Last
Student #2 Teacher
*
K - Derrick
K - Eccles
K - Majithia
K - Maronich
K - Nelson
K - Peterson
1st - Pitts
1st - Thayer
1st - Thompson
1st - Vruwink
1st - Watson
1st - Zielinski
2nd - Blau
2nd - Kepley
2nd - McDonald
2nd - Mills
2nd - Patton
3rd - Bains
3rd - Cooney
3rd - Judd
3rd - Mateer
3rd - Quattropani
4th - Gardepe
4th - Lockwood
4th - Ponder
4th - Postal
5th - Chalfant
5th - Desmond
5th - Mayer
5th - Richardson
Ext (K-2 Dev) - Bayne
Ext - Clark
Ext - Davis
Ext - Eley
Student #3 Given Name
*
First
Last
Student #3 Teacher
*
K - Derrick
K - Eccles
K - Majithia
K - Maronich
K - Nelson
K - Peterson
1st - Pitts
1st - Thayer
1st - Thompson
1st - Vruwink
1st - Watson
1st - Zielinski
2nd - Blau
2nd - Kepley
2nd - McDonald
2nd - Mills
2nd - Patton
3rd - Bains
3rd - Cooney
3rd - Judd
3rd - Mateer
3rd - Quattropani
4th - Gardepe
4th - Lockwood
4th - Ponder
4th - Postal
5th - Chalfant
5th - Desmond
5th - Mayer
5th - Richardson
Ext (K-2 Dev) - Bayne
Ext - Clark
Ext - Davis
Ext - Eley
Are you interested in being a room parent?
*
Please select
Yes
No
Please complete Room Parent Interest form
here
PARENT/GUARDIAN COMMUNICATION INFORMATION
Please provide the email address you would like to use to receive information from the PTA, including information related to your child’s classroom and/or grade level.
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)
ALL STUDENTS - CHILDREN'S THEATRE
The Children's Theatre ticket price is $18/student. You can also choose to sponsor an addition ticket or tickets for students who need it.
SCHOLARSHIP
Please Select
Sponsor an additional Children’s Theater ticket or tickets for a child who needs it. $18/student (optional)
Please Select
1 student - $18
2 students - $36
3 students - $54
5TH GRADE ONLY
Celebrate your 5th grader and spread some Selwyn pride throughout your neighborhood! Order a Class of 2026 "Where Eagles Fly" yard sign for $10 each. These signs are available for a limited time only, and orders will close on FRIDAY, SEPTEMBER 12.
How many signs would you like to order?
0
1 sign - $10
2 signs - $20
3 signs - $30
The 5th Grade Activities Fee ($50/student) funds a host of special activities and celebrations throughout the year for the 5th grade class. Later in the form, you may also choose to donate any amount to help support the activities fee for a student in need.
5th Grade Activities Fee:
I will pay at a later time
1 student - $50
2 students - $100
3 students - $150
PTA MEMBERSHIP
Joining the PTA on an annual basis gives you membership in local, state and national organizations that invest in the future of all children and promote partnerships between schools and parents. Membership dues are $10 per person / $20 per couple.
Annual Selwyn PTA Membership
Select One
Membership - 1 person ($10)
Membership - Couple ($20)
No Membership
SUMMARY
Children's Theatre - 1 Student
Price:
Children's Theatre - 2 Students
Price:
Children's Theatre - 3 Students
Price:
Children's Theatre Scholarship - 1 Student
Price:
Children's Theatre Scholarship - 2 Students
Price:
Children's Theatre Scholarship - 3 Students
Price:
Annual PTA Membership - Couple
Price:
Annual PTA Membership - 1 Person
Price:
5th Grade Sign (Qty 1)
Price:
5th Grade Sign (Qty 2)
Price:
5th Grade Sign (Qty 3)
Price:
5th Grade Activity Fee (1 student)
Price:
5th Grade Activity Fee (2 students)
Price:
5th Grade Activity Fee (3 students)
Price:
5th Grade Activity Fee Scholarship [optional]
Donate any amount to help cover the activity fee for a student in need.
Total
PAYMENT OPTIONS
How do you want to pay?
*Payment must be made online or returned to your child's teacher by
Wednesday, September 4
.
Pay with credit card
Print receipt and send into school with check
Credit Card Information
Credit card payments are processed securely through PayPal. We do not collect, process, or store your credit card information on this website. Your payment details are handled directly by PayPal's secure servers.
Credit Card
MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number
Expiration Date
Security Code
Cardholder Name
PTA Info
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