Date Date

Payable Specifics Amount Paid Payable Specifics Amount Paid

Water Water
Janitorial Services Janitorial Services
Classroom Cleaning services Classroom Cleaning services
Homeroom Project Homeroom Project
Total amount Total amount

Received from ________________________________ Received from ________________________________ the

the amount of ___________________________________ amount of _____________________________________
(P ________) as part of the contributions agreed during the (P ________) as part of the contributions agreed during the
Homeroom Meeting dated June 13, 2019. Homeroom Meeting dated June 13, 2019.

Payment covered for the month/s ___________________ Payment covered for the month/s ___________________

Signature of Parent over Treas./Teacher’s Signature of Parent over printed Treas./Teacher’s

printed Name signature over Printed Name signature over Printed
Name Name
Teacher’s Copy Parent’s Copy

Date Date
Payable Specifics Amount Paid Payable Specifics Amount Paid
Water Water
Janitorial Services Janitorial Services
Classroom Cleaning services Classroom Cleaning services
Homeroom Project Homeroom Project
Total amount Total amount

Received from ________________________________ Received from ________________________________ the

the amount of __________________________________ amount of ______________________________________
(P ________) as part of the contributions agreed during the (P ________) as part of the contributions agreed during the
Homeroom Meeting dated June 13, 2019. Homeroom Meeting dated June 13, 2019.

Payment covered for the month/s ___________________ Payment covered for the month/s ___________________

Signature of Parent over Treas./Teacher’s Signature of Parent over printed Treas./Teacher’s

printed Name signature over Printed Name signature over Printed
Name Name
Teacher’s Copy Parent’s Copy

Date Date
Payable Specifics Amount Paid Payable Specifics Amount Paid
Water Water
Janitorial Services Janitorial Services
Classroom Cleaning services Classroom Cleaning services
Homeroom Project Homeroom Project
Total amount Total amount

Received from ________________________________ Received from ________________________________ the

the amount of ___________________________________ amount of ______________________________________
(P ________) as part of the contributions agreed during the (P ________) as part of the contributions agreed during the
Homeroom Meeting dated June 13, 2019. Homeroom Meeting dated June 13, 2019.

Payment covered for the month/s ___________________ Payment covered for the month/s ___________________

Signature of Parent over Treas./Teacher’s Signature of Parent over printed Treas./Teacher’s

printed Name signature over Printed Name signature over Printed
Name Name
Teacher’s Copy Parent’s Copy