VPE H&SL Online Membership Form

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Parent/Guardian #1 Name
*

Phone Number (Parent/Guardian #1)
*

E-Mail Address (Parent/Guardian #1)
*

Home Address (Parent/Guardian #1)
*

Parent/Guardian #2 Name

Phone Number (Parent/Guardian #2)

Email Address (Parent/Guardian #2)

Address (Parent/Guardian #2) - if different

Child #1 Name
*

Child #1 Grade *

Child #1's Teacher *

Child #2 Name

Child #2 Grade

Child #2's Teacher

Child #3 Name

Child #3 Grade

Child #3's Teacher

Child #4 Name

Child #4 Grade

Child #4's Teacher

Authorization to publish information in the VPE H&SL Membership Directory

Our directory is only shared with other members of the H&SL. Your family's inclusion in our annual directory enables the VPE Community to connect with each other in numerous ways (playdates, birthday invitations, holiday cards, etc.) Please thoughtfully consider what information you feel comfortable sharing. We recommend including at least parent names and emails, child names, and teacher assignments.

*Check all that apply:

Child Name(s) & Teacher(s) - I authorize VPE H&SL to publish child name(s) and assigned teacher(s) in the VPE H&SL 2023-2024 Membership Directory.

Parent/Guardian Name(s) - I authorize VPE H&SL to publish parent/guardian name(s) in the VPE H&SL 2023-2024 Membership Directory.

Parent/Guardian Phone Number(s) - I authorize VPE H&SL to publish parent/guardian phone number(s) in the VPE H&SL 2023-2024 Membership Directory

Parent/Guardian Email Address(es) - I authorize VPE H&SL to publish parent/guardian email address(es) in the VPE H&SL 2023-2024 Membership Directory

Home Address(es) - I authorize VPE H&SL to publish the home address(es) in the VPE H&SL 2023-2024 Membership Directory

No, I do not authorize any information to be published in the 2023-2024 Membership Directory.

Which level of membership did you purchase through our website?

http://www.vpe-hsl.org/membership.html

$20 - Family Membership

$25 - Family Membership + $5 Donation

$30 - Family Membership + $10 Donation

$40 - Family Membership + $20 Donation

$50 - Family Membership + $30 Donation

$75 - Family Membership + $55 Donation

$100 - Family Membership + $80 Donation

Custom Donation

Additional Information or Comments

I will return to the Membership page, select the paw with my membership fee & donation amount and complete my donation to VPE H&SL via PayPal. *

Yes, I will go to www.vpe-hsl.org/membership.html and submit my donation via PayPal

Required

Name of individual completing this form *

Submit

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