BASIS North Central Boosters
Membership Application for 2 Adults and students
Parent Name/ Guardian
*
First Name
Last Name
Relationship to the student(s)
*
Relationship to the student (s)
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Parent Name/ Guardian
*
First Name
Last Name
Relationship to the student(s)
*
Relationship to the student (s)
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
1. Student Name
*
First Name
Last Name
What element is your student in?
*
What element is your student in?
*
2. Student Name
First Name
Last Name
What element is your student in?
What element is your student in?
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3. Student Name
First Name
Last Name
What element is your student in?
What element is your student in?
4. Student Name
First Name
Last Name
What element is your student in?
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1 Year BASIS North Central Booster Membership - Family
I understand the cost for the Boosters is $25 for the school year. This membership covers the entire family (max 2 adults) and must be renewed at the start of each school year. Membership does not guarantee availability for all volunteer opportunities. Volunteer spots are limited and filled on a first come, first served basis. I also understand that all on-campus volunteers must pass a background check. All membership payments are non-refundable, non-transferable and non-exchangeable. Failure to pass the background check does not qualify for a refund.
$
25.00
Quantity
1
2
3
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10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Signature
*
Submit
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