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					The Lewisburg Elementary PSA publishes a yearly school directory. The directory is a great
resource for communicating with other parents. To have your student included in the
directory please fill out the information below and return it to school by Friday, September
4th. This form is also available on the Lewisburg School District Website at www.lasd.us.
You may print it out and send it into school by the 4th.

* Please make sure when filling out this form you print legibly.
               This directory is not to be used for marketing or commercial use
               Do not return this form if you do not wish to be included in the Family Directory



Parent(s)/Guardian(s)

Names:

Address:

City/Zip:                                           Home Phone:

Email Address:

*Your email address will be added to our list serve for future notices about
PSA needs

Cell Phone:

Student’s Name:                                     Teacher:                            Grade

Sibling’s Name:                                     Teacher:                            Grade

Sibling’s Name:                                     Teacher:                            Grade

Sibling’s Name:                                     Teacher:                            Grade


*The PSA is asking for a donation of $5.00 per student to help cover the cost of
the Safe School Directory. Donations of any size will be welcomed. Please
make checks payable to the: Lewisburg Elementary PSA

				
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posted:8/12/2011
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