The Cornerstone Christian School
2020-2021 Scrip Enrollment Form
MUST BE COMPLETED BEFORE PLACING YOUR FIRST SCRIP ORDER
Return it to the school office or scan this form and
e-mail it to [email protected]
Cornerstone (CCS) sponsors a Scrip program which allows you to purchase Scrip. The Scrip cards you purchase
through our program generate rebates from the participating retailers. These rebates can be used as a credit
to your tuition account and/or a gift to the school.
1. For administering the Scrip program, The CCS PTFA will retain 50% of the rebates received from your
Scrip purchases as a donation.
2. CCS agrees to apply the remaining 50% balance of your rebates as designated below.
Please mark ONE option.
a. _________ Credited to your tuition account for the 2021-2022 school year*
b. _________ Credited to the tuition account of ________________________(family name) for the
2021-2022 school year*
c. _________ Credited as an additional contribution to Cornerstone Christian School
*In the event that a family does not attend CCS for the 2021-2022 school year, the rebate will be
donated to the CCS PTFA.
Please sign and date below to indicate your acknowledgement of this agreement.
Purchaser’s Signature:_______________________________________________________________________
Printed Name:____________________________________________________________________________
Spouse’s Name:____________________________________________________________________________
Student’s Name (s): _________________________________________________________________________
Address:_________________________________________________________
City:_______________________________ Zip:____________
E-mail Address:___________________________________________________________________________
Phone Number:______________________ Date:___________________