Parent's Name:

Parent's Name:

Street

City:

Zip:

Parent’s E-mail Address:  ____________________________________________________ __                            
Yes   No, I would (not) like to receive Info/ Newsletters by e-mail

Home Phone:

Cell Phone:

Business Phone:

Westside Student's Name:

Grade Level

Dean/House

$20 ( $5 goes directly to student’s House)     $10 (Staff Only)
$50 Leader of the Pack       ($10 goes directly to student’s House)

Yes, I would like an extra copy(ies) _______ of the Student directory at $4.00 each
(or 2 for $7)

Yes, I would like to purchase a Westside T-Shirt(s) ______at $12 each.(S-XL)