Sacred Heart School SCRIP Supporter Order Form

Please complete this form and return it with a check to:
Sacred Heart School SCRIP,   324 4th street,    Staples, MN 56479

Name:_____________________________________________________ Date: ___________________

Address:___________________________________E-Mail Address:______________________________

City:___________________________ State:_______ Zip Code:________ Phone:__________________

View the list of scrip at our website (www.sacredheartareaschool.org), or go to the Great Lakes Scrip site (glscrip.com) & click on retailers

Please choose an option for receiving your SCRIP Certificates:

___ I will pick certificates up at the school

___ Send certificates home with my child (sign release)

___ Other _____________________________________________________________________

Release Form: I authorize Sacred Heart School to release SCRIP to _______________________________(child’s name) for delivery to me. My signature below holds Sacred Heart School harmless from loss once SCRIP is delivered to my child. ________________________ ________________________________ ___________ (Printed name)                                                                                            (Signature)                                                            ( Date)

Merchant/Item	Denomination	Item Cost	Quantity	Total cost

                   Paid by check #: ___________________        Total order ______________

Questions & comments? Email sacredheartscrip@yahoo.com or call Cheryl 894-1527 or Teresa 894-2908