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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

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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

________________________________________________________________________________________________

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