Mt. Carmel Key Club 08-09
Mt. Carmel Key Club 08-09
Name (first and last):___________________________
Name (first and last):___________________________
Street Address: City, State, Zip:
Street Address: City, State, Zip:
_____________________________ _____________________________
_____________________________ _____________________________
Home Phone: __________________________________
Home Phone: __________________________________
Cell Phone: __________________________________
Cell Phone: __________________________________
E-mail: ______________________________________
E-mail: ______________________________________
Grade:
________
Year Joined: _______
Birthday:
________
Grade:
M /F:
________
Year Joined: _______
Authorization for student participation: I, the undersigned, authorize my child , to participate in Mt. Carmel Key Club community service activities for the year 2008-2009.
________
Birthday:
________
M /F:
________
Authorization for student participation: I, the undersigned, authorize my child , to participate in Mt. Carmel Key Club community service activities for the year 2008-2009.
Circle one (checks payable to MC Key Club): Dues & T-shirt ($26) Dues only ($13)
Circle one (checks payable to MC Key Club): Dues & T-shirt ($26) Dues only ($13)
T- Shirt Size:
T- Shirt Size:
S
M
L
XL
Parent signature
Parent signature
Student signature
Student signature
S
M
L
XL