Covington High School
PTSA Membership Form

OUR DEN WELCOMES ALL: parents, teachers, students, siblings, grandparents, friends
PLEASE PRINT CLEARLY

Student name:  ______________________________      Grade ____   Homeroom  ____________

Student name:  ______________________________     Grade ____   Homeroom _____________

Membership in the name of:                                Circle One:                                                                              

1.                                                                       Parent   Student   Teacher   Grandparent   Other

2.                                                                       Parent   Student   Teacher   Grandparent   Other

3.                                                                       Parent   Student   Teacher   Grandparent   Other

4.                                                                       Parent   Student   Teacher   Grandparent   Other

COST:  Adults-$5    Students-$3      Make checks payable to : CHS PTSA      
Please submit to Administrative Office: 
Covington High School, 73030 Lion Drive, Covington, LA  70433

Amount Enclosed:  $________