This $5s for You This $5s for You! Name* First Last School*Monthly Payroll Deduction $5 per month $10 per month $20 per month $25 per month $ Other Other AmountConsent* I hereby authorize that this monthly deduction be in effect each year until such time as I notify the District to terminate it. I understand my right to cancel this authorization at any time simply by notifying the District's Business Office.
