Parent Information

2022-2023 PTA Membership Form

Parent/Guardian Information
Welcome to the Grange Hall Elementary School PTA! Please take a moment and fill out the following fields. We have a lot of exciting things happening this year! We can't wait for you to be a part of them all.
Primary Contact Information
Parent/Guardian Name *

First Name Last Name
Email *

Confirmation Email example@example.com
Home Phone Number *
Cell Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Membership Information
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. Additional adult family members, Corporate Sponsors) - $8.00
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
Our Membership Directory is a printed directory provided to each PTA household. If you do NOT want your information published please check the box below. FYI Your name and children('s) names will still be printed.

Do not publish our contact information
Secondary Contact Information
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
Additional Comments
Student Information
Do you have a student at Grange Hall? *

Yes No
Are you a teacher or faculty member at Grange Hall? *

Yes No
1st Student's Information
Child's Name

First Name Last Name
Child's Grade & Teacher
Enter another child *

Yes No
2nd Student's Information
Child's Name

First Name Last Name
Child's Grade
Enter another child *

Yes No
3rd Student's Information
Child's Name

First Name Last Name
Child's Grade
Enter another child *

Yes No
4th Student's Information
Child's Name

First Name Last Name
Child's Grade
Enter another child *

Yes No
5th Student's Information
Child's Name

First Name Last Name
Child's Grade
Payment Information
Total Due to GHES PTA (in $US)
Payment Method *

I will mail or send in a check/cash to the school 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.

Should be Empty:

2022-2023 PTA Membership Form

Primary Contact Information

Membership Information

Secondary Contact Information

Student Information

1st Student's Information

2nd Student's Information

3rd Student's Information

4th Student's Information

5th Student's Information

Payment Information

Credit Card