Parent Information

Welcome to Grange Hall Elementary PTA! Here you will be able to submit for a PTA membership, share your communication preferences, and select any volunteer opportunities you might be interested in.

We plan to have an online directory available to PTA members this year. Please select which information you would like shared and not shared in the directory.

Parent/Guardian Name *

First Name Last Name

Email *

Confirmation Email examplte@example.com

Home Phone Number *

Cell Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

PTA Membership Level

Single Membership (if 1 GHES student in the household) - $8.00

Family Membership (if 2+ GHES students in the household) - $12.00

Teacher Membership (GHES teachers and staff only) - $8.00

Additional Family Membership (ex. Additonal adult family members, Corporate Sponsors) - $8.00

Information on where your PTA dues go

Membership Level *

If you would like to to donate additional funds to the PTA, please enter this amount below:

MemCost

Interested In:

Receiving PTA communications Volunteering during daytime activities Volunteering during nighttime activities Leading an initiative Assisting on a project

Membership Directory Opt Out:

Do not publish our Phone Number Do not publish our Address Do not publish our Email Address

2nd Parent/Guardian Name

First Name Last Name

2nd Parent/Guardian Email

Confirmation Email examplte@example.com

2nd Parent/Guardian Cell Phone Number

Is the 2nd Parent/Guardian Contact Information (Home Phone #/Address) the same as the Primary?

2nd Parent/Guardian Home Phone Number

2nd Parent/Guardian Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Additional Comments

Child's Name *

First Name Last Name

Child's Grade and Teacher

Enter another child *

Yes No

Child's Name

First Name Last Name

Child's Grade and Teacher

Enter another child *

Yes No

Child's Name

First Name Last Name

Child's Grade and Teacher

Enter another child *

Yes No

Child's Name

First Name Last Name

Child's Grade and Teacher

Enter another child *

Yes No

Child's Name

First Name Last Name

Child's Grade and Teacher

Total Due to GHES PTA (in $US)

Payment Method *

I will mail or send in a check/cash Credit Card

NOTE: If you wish to send in payment, please send in the total amount due, labeled PTA membership to the attention of the PTA Treasurer AND make sure your name and the name of your child/children is included with your payment.

My Products

USD Please Enter Your Total Due From Above

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

2019 - 2020 PTA Membership Form

Primary Contact Information

Membership Information

Secondary Contact Information (Family Membership)

Student Information

1st Student's Information

2nd Student's Information

3rd Student's Information

4th Student's Information

5th Student's Information

Payment Information