I am a: Parent / Guardian Teacher (if teacher with no children at BCA please just list info under correct gender)

Father / Male Guardian Last Name

Father / Male Guardian First Name

Home Address

Home Phone

Work Phone

Fathers Cell Phone

Father / Guardian Email Address

Mother / Female Guardian Last Name

Mother / Female Guardian First Name

Home Address

Home Phone

Work Phone

Cell Phone

Mother Email Address

Student 1 Name

Grade of Student 1 K 1st 2nd 3rd 4th 5th 6th 7th 8th

Student 2 Name

Grade of Student 2 K 1st 2nd 3rd 4th 5th 6th 7th 8th

Student 3 Name

Grade of Student 3 K 1st 2nd 3rd 4th 5th 6th 7th 8th

Student 4 Name

Grade of Student 4 K 1st 2nd 3rd 4th 5th 6th 7th 8th

I would like to become a member of the BCA PTO and I am committing to pay the $10 fee to join. I know this fee will include a free BCA PTO T-shirt. Yes No

Size of BCA PTO T-Shirt (The one included in the BCA PTO Membership Fee) No Shirt Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large

Please indicate if you would like more than One BCA PTO T-shirt. Each additional T-shirt will be $10. We have Adult Small through Adult XXL. Yes No

Please indicate number and sizes of additional T-shirts.

Please make all Checks Payable to BCA PTO. You may mail or drop it off at the school during school hours. Please indicate which option in how you will be handling your check. Mail In Drop off at School

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