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Back to School Form
STUDENT INFORMATION
How many children attend Selwyn?
*
1
2
3
Student #1 Given Name
*
First
Last
Student #1 "Goes By" Name
If different than Given Name.
Student #1 Teacher
*
K - Abbate
K - Demmitt
K - Derrick
K - Fisher
K - Mateer
K - Sparks
1st - Goodson
1st - Thayer
1st - Valois
1st - Vande Weghe
1st - Vruwink
2nd - Draper-Hager
2nd - Headd
2nd - McDonald
2nd - Patton
2nd - Powers
3rd - Brownlow
3rd - Chalfant
3rd - Kepley
3rd - Majithia
3rd - Muth
3rd - Smyth
4th - Ashley
4th - Lockwood
4th - Mills
4th - Postal
5th - Kuykendall
5th - Lin
5th - Richardson
5th - Watson
A-team - Clark
A-team - Davis
A-team - Eley
Student #1 T-shirt Size
*
All students will receive a t-shirt to be worn throughout the year.
YS
YM
YL
YXL
AS
AM
Student #2 Given Name
*
First
Last
Student #2 "Goes By" Name
If different than Given Name.
Student #2 Teacher
*
K - Abbate
K - Demmitt
K - Derrick
K - Fisher
K - Mateer
K - Sparks
1st - Goodson
1st - Thayer
1st - Valois
1st - Vande Weghe
1st - Vruwink
2nd - Draper-Hager
2nd - Headd
2nd - McDonald
2nd - Patton
2nd - Powers
3rd - Brownlow
3rd - Chalfant
3rd - Kepley
3rd - Majithia
3rd - Muth
3rd - Smyth
4th - Ashley
4th - Lockwood
4th - Mills
4th - Postal
5th - Kuykendall
5th - Lin
5th - Richardson
5th - Watson
A-team - Clark
A-team - Davis
A-team - Eley
Student #2 T-shirt Size
*
All students will receive a t-shirt to be worn throughout the year.
YS
YM
YL
YXL
AS
AM
Student #3 Given Name
*
First
Last
Student #3 "Goes By" Name
If different than Given Name.
Student #3 Teacher
*
K - Abbate
K - Demmitt
K - Derrick
K - Fisher
K - Mateer
K - Sparks
1st - Goodson
1st - Thayer
1st - Valois
1st - Vande Weghe
1st - Vruwink
2nd - Draper-Hager
2nd - Headd
2nd - McDonald
2nd - Patton
2nd - Powers
3rd - Brownlow
3rd - Chalfant
3rd - Kepley
3rd - Majithia
3rd - Muth
3rd - Smyth
4th - Ashley
4th - Lockwood
4th - Mills
4th - Postal
5th - Kuykendall
5th - Lin
5th - Richardson
5th - Watson
A-team - Clark
A-team - Davis
A-team - Eley
Student #3 T-shirt Size
*
All students will receive a t-shirt to be worn throughout the year.
YS
YM
YL
YXL
AS
AM
PARENT/GUARDIAN COMMUNICATION INFORMATION
Please provide the email address you would like to use to receive information from the PTA. This includes emails sent from room parents in your child’s class as well as the grade level emails. * Please include a mobile number if you would like to receive text reminders from the PTA. NOTE: You must sign up for the text option EVERY year.
Parent/Guardian Name(s)
*
First
Last
Address (Please include street types: Dr, Ln, St, Rd, Cir, Pl, Ave)
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
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)
Additional Address (Please include street types: Dr, Ln, St, Rd, Cir, Pl, Ave)
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
DIRECTORY
The Selwyn Directory is available on-line and in print. The Directory will automatically include the name, grade and teacher of all students enrolled at Selwyn. Inclusion of contact information is optional. If you would like to have your student’s contact information published in the Directory, you are required to grant permission by checking “yes” the box below and provide the following information. If you do not wish your student’s contact information to be published please select “no”.
Directory Permission
*
I hereby grant permission for Selwyn Elementary School PTA to publish the provided information in the Selwyn Elementary School Directory.
Yes
No
Opt Out of Printed Directory
I would like to opt out of receiving the printed Directory. I will still have access to the on-line Directory.
Parents reside separately and both would like to be included in the directory.
No
Yes
How many additional directories do you want to order?
First copy is free to each family. Each additional copy is $4/each.
0
1
2
3
ROOM PARENT
Room Parents are responsible for recruiting and scheduling volunteers, maintaining the online class calendar, and regularly communicating with the teacher and parents. If you are interested in being a room parent for your child's class, please indicate below.
If you are interested in being a room parent for your child's class, please select the class(es) below where you are willing to serve.
[More than one class can be selected by holding the CTRL key. ]
I am not interested in being a room parent this year
K - Abbate
K - Demmitt
K - Derrick
K - Fisher
K - Mateer
K - Sparks
1st - Goodson
1st - Thayer
1st - Valois
1st - Vande Weghe
1st - Vruwink
2nd - Draper-Hager
2nd - Headd
2nd - McDonald
2nd - Patton
2nd - Powers
3rd - Brownlow
3rd - Chalfant
3rd - Kepley
3rd - Majithia
3rd - Muth
3rd - Smyth
4th - Ashley
4th - Lockwood
4th - Mills
4th - Postal
5th - Kuykendall
5th - Lin
5th - Richardson
5th - Watson
A-team - Clark
A-team - Davis
A-team - Eley
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 $7 per person / $14 per couple. Please contact Lori Welke at 503-956-8591 if you would like a membership card.
2021-2022 Selwyn PTA Membership
Select One
Membership - 1 person ($7)
Membership - Couple ($14)
No Membership
5TH GRADE ONLY
Celebrate your graduating 5th grader and spread some Selwyn pride throughout your neighborhood! Order "Where Eagles Fly" yard sign for $15 each.
How many signs would you like to order?
0
1 sign - $15
2 signs - $30
3 signs - $45
5th Grade Activity Fee: This pays for the Whitewater Center field trip fee and other special events throughout the year.
I will pay at a later time
1 student - $30
2 students - $60
3 students - $90
5th Grade Activity Fee/Scholarship - If you would like to help scholarship another student, any amount is appreciated!
SUMMARY
2020-21 PTA Membership - Couple
Price:
2020-21 PTA Membership - 1 Person
Price:
Additional Directories (Qty 1)
Price:
Additional Directories (Qty 2)
Price:
Additional Directories (Qty 3)
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:
Total
$0.00
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 paypal (will be directed to paypal after submitting form)
Print receipt and send into school with check
To prevent spam, solve this simple math problem below.
PTA Info
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