Name __________________________________________________________________

Address ________________________________________________________________

Phone ______________________________Email_______________________________

Children’s names and ages __________________________________________________

______ $5.00 per person or

______ please waive dues/membership scholarship

______ + additional tax deductible donation

______ + $5.00 to sponsor a teacher ____________________________(name of teacher)

__________________________________________________________(school name)

______ TOTAL

Permission for photos (for the period of Sept 2004-Sept 2005)

______ I give permission for my child’s or my likeness to be photographed and placed in the Rainman.

______ I do not give my permission for my child or my likeness to be photographed and placed in the Rainman.

Signature__________________________________________date_______________

In order to insure privacy, a unique link to the Rainman will be emailed to every member for each edition. Only first names of the children will be given and no addresses or phone numbers will be published unless permission is granted. Adults may choose to have only their first name published as well and a permission request will be signed and kept on file before any photo is placed in the Rainman.