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Your “Family Name” will go down in history on a Name Brick.
As part of our Fundraising endeavours for this year, Seabrook Primary School would like to offer you the
opportunity to purchase a Name Brick for $35.00 each which entitles YOU to have YOUR family’s name
engraved onto the brick as a lasting record of your child/children’s primary years at Seabrook Primary
School.
The BRICKS will be permanently installed in the improved area around the new North Wing Building.
Please complete the order form below and return it to the school in an envelope (along with $35.00)
marked “Family Name Bricks” no later than the Friday the 29th of May 2015.
Order Form – “Family Name Bricks”
If you would like your name to go down in history, please complete the section below:
FAMILY NAME:
Name: ____________________________________________
1 x Family Name Brick @ $35.00 each
Room #: ________________
Grade: __________
TOTAL AMOUNT ENCLOSED: $___________________________
(Please use correct amount of money, as change will not be given.
Alternatively, you may provide your credit card details below).
 Visa
 Mastercard
Total Amount: $________________
Name on Card: _______________________________________________ Phone Number: ______________________
Card Number: ___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___
Expiry: _____ /_____
Signature: __________________________________________________________ Date: ___________________