Weipa Campus

PARENTS AND CITIZENS ASSOCIATION

MEMBERSHIP FORM

NAME _______________________________________________________________________________________

ADDRESS ___________________________________________________________________________________

_____________________________________________________________________________________________

PHONE ___________________ FAX ______________________________________________________

EMAIL ADDRESS _____________________________________________________________________________

PARENT / CAREGIVER / CITIZEN (Please circle as appropriate)

CHILDREN AT SCHOOL ____________________________________

____________________________________

____________________________________

____________________________________

I AM INTERESTED IN HELPING THE P & C BY _______________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

I APPLY FOR MEMBERSHIP OF THE WESTERN CAPE COLLEGE WEIPA CAMPUS PARENTS AND CITIZENS ASSOCIATION FOR ______________ (YEAR).

SIGNED ___________________ APPROVED ________________________

(President)

DATE ___________________ DATE ________________________