Pledge Form

Spring Fund Drive 2026

1Family information

Parent / donor name

Rebecca Tran

[email protected]

Phone — optional

(555) 264-7710

Student name

Olivia Tran

Grade

3rd

Teacher

Ms. Alvarez

2My pledge

$25

$50

$100

$250

Other amount$ 60

Please direct my pledge to

4th-grade science camp trip

3Payment

Card — last four only; the full number is captured securely

•••• •••• •••• 4242 Processed securely. Full card number and CVV are never written on this form.

Check enclosed, payable to Maplewood PTA

4Matching gift

Many employers double your gift — optional

Employer

Northgate Health

Will match?

Yes

Rebecca Tran

Donor signature

Date

June 18, 2026

Thank you for supporting Maplewood Elementary! Maplewood PTA is a registered 501(c)(3); your gift is tax-deductible and 100% stays at our school. Pledges fund the programs our students love most — field trips, classroom libraries, art and music supplies, and the science lab.