BHS Project Grad 2011 Registration Form

Student’s name
(Last name, First Name)
Home Phone: Cell Phone: Email:
Student’s
Phone/Email

Mailing Address/
City/Zip
Mother/Guardian’s Name
(circle one)
Home Phone: Cell Phone: Email:
Mother/Guardian’s
Phone/Email
Father/Guardian’s Name
(circle one)
Home Phone: Cell Phone: Email:
Father/Guardian’s
Phone/Email
Other Contact Person
(Name and Relationship)
Home Phone: Cell Phone: Email:
Contact’s
Phone/Email
T-Shirt Size
XS SM MED LG XL XXL
(Circle Size)

The student named above will participate in Baldwin High School Project Graduation 2011 on Friday,
May 20, 2011, 9:00 pm until Saturday, May 21, 2011, 6:00 am. Enclosed is the $75 non-refundable
registration payment. Please make check payable to: BHS Project Graduation. The registration form
and payment must be received or postmarked by March 25, 2011 to guarantee student’s participation in
Project Grad.

____________________________________________________
Signature of Student Date

____________________________________________________
Signature of Mother / Legal Guardian Date

____________________________________________________
Signature of Father / Legal Guardian Date

Mail Registration Form and Payment to:

2011 BHS Project Graduation • P.O. Box 536 • Puunene, HI 96784-0536