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Scrip Program Agreement

SCRIP PROGRAM AGREEMENT

26-27 School Year

Canaan Christian Academy sponsors a scrip program which allows you to purchase scrip. The scrip you purchase through our program generates rebates from the participating retailers. These rebates can be used as a credit to your tuition account and/or a gift to the school.

You need to agree as follows and sign and submit the form with your choices filled in for disbursing your rebates earned.

5% of the rebate earned will be held for the costs of the program with the remaining 95% divided as you indicate below.
Rebates will be applied to your account twice a year.
Checks or money orders will be accepted as payment. Please do not send cash. Checks are to be made payable to Canaan Christian Academy. Your may also pay online with your bank account or credit card.
All completed orders are due each Monday at 9 a.m. to the academy office. Late orders will be held for the following week. Orders are submitted every Monday morning by 9 a.m. year-round except the week of Christmas break.
Gift cards will be held in the office or delivered to an adult family member unless we are directed otherwise by you filling out the disclaimer at the bottom of this form.
The gift cards are like cash. Neither Canaan Christian Academy nor the scrip coordinator will be responsible for lost of misplaced gift cards.
We will not accept returns on gift cards purchased for any reason. If you have a question about a card, research the card on raiseright.com before ordering.
If a non-sufficient fund check is written, you will incur a $20 fee to be paid to Canaan Christian Academy. After two NSF checks are tendered on your account, only money orders will be accepted.

We make no representations or warranties of any kind with respect to the scrip. This agreement continues unless replaced by another and can be terminated by either Canaan Christian Academy or you upon 60 days advance notice to the other.

Your Name*

Answer required for "Your Name"

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Phone number*

Number Required

Please choose below how you want your 95% earnings to be applied. If you want a different percentage than what is listed, you can use the other option to tell us what percentage you want (not to exceed 95%) and what family you want it applied to.

Answer required for "Please choose below how you want your 95% earnings to be applied. If you want a different percentage than what is listed, you can use the other option to tell us what percentage you want (not to exceed 95%) and what family you want it applied to."

95% tuition credit for my family account

95% as a charitable contribution to the school

Other:

Complete the next section ONLY if you would like your scrip cards released to a student. This student will ONLY receive the envelope of cards ordered under your account number. Scrip cards will not be sent home with this student if you do not sign the disclaimer.

I authorize Canaan Christian Academy's scrip program coordinator and/or volunteers to release my scrip cards to the following person. I will not hold CCA or the coordinator responsible for any lost or misplaced cards.

Student's Name*

Answer required for "Student's Name"

Signature*

Signature Required

Date signed*

Answer required for "Date signed"

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"