4th Grade Field Trip Refund Information Form

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Unfortunately 4th grade was unable to go on two scheduled field trips due to school closure. Atlanta History Center ($14) and the Atlanta Zoo ($16). You are due a refund of $30.00. Please note, your refund due may be less depending on payments to date received.

Email *

Student's Name (one student per form please) *

Teacher's Name *

Parent/Guardian's Name *

Would you like F.AVE to issue a check for your refund? *

Yes. I've provided my name and address in the following questions.

No. Please donate my refund to next years 4th grade field trips to support a student in need.

No. Please keep my refund for use for my child's field trips for next year.

If you would like to receive a refund please provide the NAME(s) of the person the check should be made out to. If the refund needs to be split between two households, (meaning you need two checks) please be sure to provide both names and note that in your answer below. *

If you would like to receive a refund please provide the ADDRESS the check should be mailed to. If the refund needs to be split between two households, (meaning you need two checks), please be sure to provide both addresses and note that in your answer below. *

If you have any questions or comments please feel free to write them below. Otherwise, please email Jessica Wentworth directly at jwentworth@csdecatur.net

A copy of your responses will be emailed to the address you provided.

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