St.
Ursula Academy Scrip Program Registration
Participant Name(s) __________________________________________________________
Address ____________________________________________________________________
City
_____________________________ State _______________
Zip__________________
Home Phone ( )
__________________ Work Phone ( )
__________________________
Email Address for Scrip Correspondence
_________________________________________
Student’s First Name: __________________ Student’s Last
Name:_____________________
Student’s First Name: __________________ Student’s Last Name:_____________________
Student’s First Name: __________________ Student’s Last
Name:_____________________
Amount of earnings will be credited equally to the above named tuition
accounts.
Participant
has read, does understand, and will abide by the general policies of the St.
Ursula Academy Scrip Program. The
participant further understands that email will be the official method of
communication of the St. Ursula Academy Scrip Program. All official correspondence will be
distributed from the email address scrip@toledosua.org.
_________________________________
Signature
_________________________________
Printed Name
_________________________________
Date
After your registration form
is submitted, scrip orders may commence.
We recommend submitting your
registration forms with your first check!