5th Grade Form

5th Grade Information Form

To facilitate CIMI refunds and also 5th grade culmination events, please fill out the information below. If you have any questions you can contact the 5th Grade coordinator at 5thgrade@parkwesternpta.org

* Indicates required field

Student's Name *

First

Last

Room Number or Teacher *

Guardian Name *

First

Last

Guardian Contact Email. If multiple emails, separate with a comma. *

Contact Phone Number (optional) *

5th Grade Culmination T-shirt Size *

If you are receiving a refund for CIMI would you like to donate your refund to the PTA? *

YES NO

To receive your refund for CIMI please tell us the name of the person who you'd like us to make the refund check out to? If there is more than one person please list in the second space provided.

Person #1: First and Last Name *

Amount of Refund *

Person #1: Address to Mail the Refund Check (We will send the refund check to this address) *

Line 1

Line 2

City

State

Zip Code

Country

Person #2: First and Last Name (If needed) *

Amount of Refund *

Person #2: Address *

Line 1

Line 2

City

State

Zip Code

Country

Comment *

Submit

INFORMATION

FORM - Please fill out the following:

Student Name
Room/Teacher
Guardian Name
Guardian Contact info
Choose a shirt size
CIMI REFUND INFO
Contact info for future events

CIMI INFO
**If you are receiving a refund for your CIMI payment please be aware that only direct payments will be refunded. All fundraising money your student may have collected will remain in the 5th grade general fund .

Please fill out refund information by May 31, 2020. Any funds remaining in the CIMI account will be considered donations and be added to the general fund.

T-SHIRT
Every student will receive a free 5th Grade culmination t-shirt, PLEASE tell us your size. There will be very limited sizes available for trades. Please order a size larger if you are unsure.

POSTER
Students will receive a free 8x5" postcard of our 75 year photo. Families can purchase a discounted 18x24 poster of the 75 year photo here for a limited time.

FUTURE EVENTS
In the event that we are able to have gatherings this summer we will try to plan for a 5th grade picnic at Peck Park sometime in June or July if the situation permits. We will contact students with an invitation via email if this is possible.

YEARBOOK OPPORTUNITIES!

If you would like to have your baby picture in the yearbook please send it to the email below.
If you would like to have your colonial picture in the yearbook dress up and get a nice shot in good lighting. Bonus if you have props! Please send it to the email below.
If you have questions please send to the email below.

5thgrade@parkwesternpta.org

THANKS!

Thank you! CIMI refunds will be sent starting May 4th.