2021-2022 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, Venmo or by check. 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, Field Day, etc)

Teacher Appreciation Events (TBD)

5K Committee (Planning, Fundraising)

Option 5

Wissahickon Sustainability Council (aka Green Committee)

Please see instructions for paying for your HSA membership via Paypal, Venmo or check after you submit your responses! Suggested dues are $5 per family. Any additional donations are appreciated! PayPal: @CookWissHSA2021 Venmo: CookWissHSA Check: Cook Wissahickon HSA (please place in envelope labeled HSA and return to homeroom teacher) Questions about payment? Email cookwissahickontreasurer@gmail.com

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