Spring Glen School PTA Membership Form Membership Level (Check One) – Includes SPG PTA, Town-wide PTA, & State PTA Memberships. *Individual (1 vote) – Suggested Donation of $15Family (2 votes) – Suggested Donation of $30Teacher/Staff (1 vote) – Suggested Donation of $15Community (1 vote) – Suggested Donation of $15Directory / Contact Info Only Adult Information SectionAdult Member 1 (Parent / Guardian, Teacher / Staff, Community member) *FirstLastAdult Member #1 Email *Adult Member #1 PhoneAdult Member #1 AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAdult Member #2 (Parent / Guardian, Teacher / Staff, Community member)FirstLastAdult Member #2 EmailAdult Member #2 PhoneAdult Member #2 Address isSame as Adult Member #1Different as Adult Member #1Third ChoiceAdult Member #2 AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePayment SectionSuggested donation is $15 for and Individual, Community, Teacher/Staff Memberships, $30 for a Family Membership: *Dues – Pay What You Can. Dues are a suggested donation (SD) of $15 for an Individual or Community (Teacher) Membership and $30 for a Family Membership. All are welcome. Pay what you can. Or make an additional donation to support our programming and to help cover membership dues for those who need it. Donations – Please consider donating to the SPG PTA general fund. Your donation will help support the school in many ways including classroom & playground supplies, assemblies, teacher grants & appreciation, Art Day, Field Day, and more. The PTA spends approximately $90 a year per student. Anything additional you can donate will make a difference! Enter the amount you would like to donate.Online processing fees (About $1 a Membership)1 Membership2 Memberships3 Totaling near $100 with donation 4 Totaling near $150 with donation 5 Totaling near $200 with donation No thank youPlease help offset the fee for paying online. Total Amount *$ 0.00Child(ren) Information SectionStudent 1 Name FirstLastGrade (Student 1)KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeTeacher (Student 1)K – Teacher assignment haven't been made yetK – Mrs. BauknechtK – Mrs. LavorgnaK – Mrs. Rosenberg1 – Teacher assignment haven't been made yet1 – Ms. Dorso1 – Mrs. Mir1 – Ms. O'Neill2 – Teacher assignment haven't been made yet2 – Ms. Bradley2 – Mrs. Burkholz2 – Mrs. Richard3 – Teacher assignment haven't been made yet3 – Mrs. DiFonzo3 – Mrs. Reynolds3 – Mrs. Riley4 – Teacher assignment haven't been made yet4 – Mr. Esposito4 – Mrs. Dwelle (Ms. Hartman)4 – Mr. Yelenik5 – Teacher assignment haven't been made yet5 – Mrs. Amodio5 – Ms. Irwin5 – Mr. Melillo6 – Teacher assignment haven't been made yet6 – Ms. Nelson6 – Mrs. Prince6 – Mr. TramaStudent 2 NameFirstLastGrade (Student 2)KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeTeacher (Student 2)K – Teacher assignment haven't been made yetK – Mrs. BauknechtK – Mrs. LavorgnaK – Mrs. Rosenberg1 – Teacher assignment haven't been made yet1 – Ms. Dorso1 – Mrs. Mir1 – Ms. O'Neill2 – Teacher assignment haven't been made yet2 – Ms. Bradley2 – Mrs. Burkholz2 – Mrs. Richard3 – Teacher assignment haven't been made yet3 – Mrs. DiFonzo3 – Mrs. Reynolds3 – Mrs. Riley4 – Teacher assignment haven't been made yet4 – Mr. Esposito4 – Mrs. Dwelle (Ms. Hartman)4 – Mr. Yelenik5 – Teacher assignment haven't been made yet5 – Mrs. Amodio5 – Ms. Irwin5 – Mr. Melillo6 – Teacher assignment haven't been made yet6 – Ms. Nelson6 – Mrs. Prince6 – Mr. TramaStudent 3 NameFirstLastGrade (Student 3)KindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeTeacher (Student 3)K – Teacher assignment haven't been made yetK – Mrs. BauknechtK – Mrs. LavorgnaK – Mrs. Rosenberg1 – Teacher assignment haven't been made yet1 – Ms. Dorso1 – Mrs. Mir1 – Ms. O'Neill2 – Teacher assignment haven't been made yet2 – Ms. Bradley2 – Mrs. Burkholz2 – Mrs. Richard3 – Teacher assignment haven't been made yet3 – Mrs. DiFonzo3 – Mrs. Reynolds3 – Mrs. Riley4 – Teacher assignment haven't been made yet4 – Mr. Esposito4 – Mrs. Dwelle (Ms. Hartman)4 – Mr. Yelenik5 – Teacher assignment haven't been made yet5 – Mrs. Amodio5 – Ms. Irwin5 – Mr. Melillo6 – Teacher assignment haven't been made yet6 – Ms. Nelson6 – Mrs. Prince6 – Mr. TramaAdditional StudentsPlease include Name, Grade, and teacher of any additional students you have attending SPG.Educating as School StaffSpecials Teacher (Art, Gym, Media, Music) Specialists and Student SupportKindergarten TeacherFirst Grade TeacherSecond Grade TeacherThird Grade TeacherFourth Grade TeacherFifth Grade TeacherSixth Grade TeacherOtherStudents (If applicable) Please include Name, Grade, and teacher of any additional students you have attending SPG.Directory Information SectionWhen we can we aim to create a directory with the information collected. Please let us know what to include. What can we list?Child(ren) names and grades Adult Name(s)Address(es)Phone number(s)Email(s)Can we list your name and school email address?YesNoAdditional InformationVolunteer – The PTA is run by people like you. Are you interested in serving on a committee? The PTA is run by people like you and we appreciate you and your input. Please consider joining or learning more about any of the below committees. You can join a committee at any time. It is encouraged but not required to join a committee. Let us know which Committees you are interested in, if any.Open SPG PTA E-Board PositionsVice PresidentVP Diversity & InclusionVP FundraisingAbove option but as co-chairOtherAfterschool Enrichment (Coordinator(s)/Committee/Educator)Yes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about it5K CommitteeYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itBook Fair / Reading Challenge / Author VisitYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itCommunications / Social Media / WebsiteYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itDiversity and InclusionYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itFundraisingYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itOutdoor Committee (Nature's Classroom)Yes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itNew Family Playdates (late Spring / Summer)Yes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itCampout CommitteeYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itSomeone Special DanceYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itVoluntary DirectoryYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itSchool PlayYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itTeacher Appreciation / GrantsYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itYearbook – all gradesYes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about it6th Grade Committee Yes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itHamden PTA Council Positions or Committees Yes please Adult 1Yes please Adult 2No thanksMaybe, I’d/We’d like to know more about itOther – Have an idea? Email: Secretary@SpringGlenPTA.org or Membership@SpringGlenPTA.orgLearn about our town's Special Education PTA (SEPTA) at www.HamdenSEPTA.orgThanks, I'll check it out!No Thanks, I'm not interested this year.Submit
