2019-20 CW HSA Membership Form

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Please fill out the following to become a member of the Cook-Wissahickon HSA. Please note, your information will all be private and will not be shared with any third parties. After you submit you'll see instructions for donating via Paypal or by check or cash if you'd like! Thanks so much for your involvement - we're looking forward to a great year!

Parent/Guardian 1 First Name: *

Parent/Guardian 1 Last Name: *

Email *

Parent/Guardian 2 Name

Student 1 First Name (If non-guardian member, please type N/A) *

Student 1 Last (If non-guardian member, please type N/A) *

Student 1 Grade *

Student 1 Homeroom Teacher

Student 2 First Name

Student 2 Last Name

Student 2 Grade

Student 2 Homeroom Teacher

Student 3 First Name

Student 3 Last Name

Student 3 Grade

Student 3 Homeroom Teacher

Please add any additional student names/grades here.

Do you wish to receive HSA news and announcements *

Yes

No (Only check if you do not want to receive HSA emails.)

Are you interested in being contacted specifically for for any of the following volunteer needs?

Classroom Parent (Ongoing)

School Activities (Book Fairs, Movie Night, Holiday Shop, Field Day, etc)

Teacher Appreciation Events (TBD)

5K Committee (Planning, Fundraising, etc for Fall 2019 event)

Schoolyard Cleanups (TBD throughout the year)

Wissahickon Sustainability Council (aka Green Committee)

Please see instructions for paying for your HSA membership via Paypal or cash or check after you submit your responses! Suggested dues are $5 per family. Any additional donations are appreciated! Thanks! Questions about payment? Email cookwissahickontreasurer@gmail.com

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