Back to School Form

STUDENT INFORMATION

How many children attend Selwyn?*

Student #1 Name*

First Last

Student #1 "Goes By" Name

Student #1 Teacher*

Student #1 T-shirt Size*

All students will receive a t-shirt to be worn throughout the year for Red Ribbon Reading as well as field trips.

Student #2 Name*

First Last

Student #2 "Goes By" Name

Student #2 Teacher*

Student #2 T-shirt Size*

All students will receive a t-shirt to be worn throughout the year for Red Ribbon Reading as well as field trips.

Student #3 Name*

First Last

Student #3 "Goes By" Name

Student #3 Teacher*

Student #3 T-shirt Size*

All students will receive a t-shirt to be worn throughout the year for Red Ribbon Reading as well as field trips.

PARENT/GUARDIAN COMMUNICATION INFORMATION

Please provide the e-mail(s) you would like to use to receive information from the PTA. This includes e-mails sent from room parents in your child's class as well as the grade level list emails. Please include a mobile number if you would like to receive text reminders from the PTA. NOTE: You must sign up for text option EVERY year.

Parent/Guardian Name

First Last

Parent/Guardian Email

Mobile Phone

(Please use this format XXX-XXX-XXXX)

Additional Parent/Guardian Name

First Last

Additional Parent/Guardian Email

Additional Mobile Phone

(Please use this format XXX-XXX-XXXX)

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. Parents will be chosen by lottery the week of September 3rd and a mandatory Room Parent training on September 11th for selected volunteers.

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. ]

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 Laura Patton at 704-804-2744 if you would like a membership card.

2018-2019 Selwyn PTA Membership

DIRECTORY

The Selwyn Directory is an invaluable source of contact information for classmates, school staff, and the PTA Board. 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.

Parent Name(s) for Directory*

First Last

Address (Please include street types: Dr, Ln, St, Rd, Cir, Pl, Ave)*

Street Address City State ZIP Code

Email Address*

Phone*

(Please use this format XXX-XXX-XXXX)

Parents reside separately and both would like to be included in the directory.

Additional Parent Name(s) for Directory

First Last

Parent Address (Please include street types: Dr, Ln, St, Rd, Cir, Pl, Ave)

Street Address City State ZIP Code

Email Address

Phone

(Please use this format XXX-XXX-XXXX)

How many additional directories do you want to order?

First copy is free to each family. Each additional copy is $3/each.

CHILDREN'S THEATRE

Every grade attends a Children's Theatre Production at ImaginOn. For the schedule, visit the calendar on our website. WE HAVE TO PAY CHILDREN'S THEATRE IN ADVANCE SO PAYMENT IS REQUIRED NOW. Tickets are $10 per student.

Please select number of students.*

YEARBOOK

Selwyn yearbooks are available to every student. They will also be available for sale in the Spring. Purchase yours now and mark it off your list!

How many yearbooks do you want to order?

5TH GRADE ONLY

Celebrate your graduating 5th grader and spread some Selwyn pride throughout your neighborhood! Order "An Eagle is Leaving the Nest" yard sign for $15 each. Available for pick up at Back-To-School Night.

How many signs would you like to order?

5th Grade Activity Fee ($40 per student): This pays for the Whitewater Center field trip and other special events throughout the year.

Please select number of 5th Grade students.

5th Grade Activity Fee/Scholarship - If you would like to help scholarship another student, any amount is appreciated!

SUMMARY

2017-2018 PTA Membership - Couple

Price: $14.00

2017-2018 PTA Membership - 1 Person

Price: $7.00

Additional Directories (Qty 1)

Price: $3.00

Additional Directories (Qty 2)

Price: $6.00

Additional Directories (Qty 3)

Price: $9.00

Yearbook (Qty 1)

Price: $15.00

Yearbooks (Qty 2)

Price: $30.00

Yearbooks (Qty 3)

Price: $45.00

Children's Theatre Tickets (1 student)

Price: $10.00

Children's Theatre Tickets (2 students)

Price: $20.00

Children's Theatre Tickets (3 students)

Price: $30.00

5th Grade Sign - 1 sign

Price: $15.00

5th Grade Sign - 2 signs

Price: $30.00

5th Grade Sign - 3 signs

Price: $45.00

5th Grade Activity Fee

Price: $0.00

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 5.

To prevent spam, solve this simple math problem below.

K - Abbate
K - Demmitt
K - Derrick
K - Headd
K - Kellam
K - Kivuti
K - Mateer
1st - Black
1st - Goodson
1st - Roberts
1st - Shockley
1st - Valois
1st - Vande Weghe
1st - Vruwink
2nd - Biggs
2nd - Council
2nd - Draper-Hager
2nd - Hayes
2nd - Patton
2nd - Thayer
3rd - Brownlow
3rd - Chalfant
3rd - Dillard
3rd - McDonald
3rd - Smyth
3rd - Williams
4th - Burleson
4th - Gardepe
4th - Lockwood
4th - Mills
4th - Muth
5th - Gordon
5th - Kuykendall
5th - Lin
5th - Richardson
5th - Thomas
A-team - Clark
A-team - Davis
A-team - Eley

K - Abbate
K - Demmitt
K - Derrick
K - Headd
K - Kellam
K - Kivuti
K - Mateer
1st - Black
1st - Goodson
1st - Roberts
1st - Shockley
1st - Valois
1st - Vande Weghe
1st - Vruwink
2nd - Biggs
2nd - Council
2nd - Draper-Hager
2nd - Hayes
2nd - Patton
2nd - Thayer
3rd - Brownlow
3rd - Chalfant
3rd - Dillard
3rd - McDonald
3rd - Smyth
3rd - Williams
4th - Burleson
4th - Gardepe
4th - Lockwood
4th - Mills
4th - Muth
5th - Gordon
5th - Kuykendall
5th - Lin
5th - Richardson
5th - Thomas
A-team - Clark
A-team - Davis
A-team - Eley

K - Abbate
K - Demmitt
K - Derrick
K - Headd
K - Kellam
K - Kivuti
K - Mateer
1st - Black
1st - Goodson
1st - Roberts
1st - Shockley
1st - Valois
1st - Vande Weghe
1st - Vruwink
2nd - Biggs
2nd - Council
2nd - Draper-Hager
2nd - Hayes
2nd - Patton
2nd - Thayer
3rd - Brownlow
3rd - Chalfant
3rd - Dillard
3rd - McDonald
3rd - Smyth
3rd - Williams
4th - Burleson
4th - Gardepe
4th - Lockwood
4th - Mills
4th - Muth
5th - Gordon
5th - Kuykendall
5th - Lin
5th - Richardson
5th - Thomas
A-team - Clark
A-team - Davis
A-team - Eley

I am not interested in being a room parent this year
K - Abbate
K - Demmitt
K - Derrick
K - Headd
K - Kellam
K - Kivuti
K - Mateer
1st - Black
1st - Goodson
1st - Roberts
1st - Shockley
1st - Valois
1st - Vande Weghe
1st - Vruwink
2nd - Biggs
2nd - Council
2nd - Draper-Hager
2nd - Hayes
2nd - Patton
2nd - Thayer
3rd - Brownlow
3rd - Chalfant
3rd - Dillard
3rd - McDonald
3rd - Smyth
3rd - Williams
4th - Burleson
4th - Gardepe
4th - Lockwood
4th - Mills
4th - Muth
5th - Gordon
5th - Kuykendall
5th - Lin
5th - Richardson
5th - Thomas
A-team - Clark
A-team - Davis
A-team - Eley

STUDENT INFORMATION

PARENT/GUARDIAN COMMUNICATION INFORMATION

ROOM PARENT

PTA MEMBERSHIP

DIRECTORY

CHILDREN'S THEATRE

YEARBOOK

5TH GRADE ONLY

SUMMARY

PAYMENT OPTIONS

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