SMV SCRIP Permission/Waiver of Claim Form

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New waiver form MUST be filled out EVERY year!!

Email *

Family Name *

I give permission to St. Mary's Visitation School to deliver SCRIP, which I have ordered from the parish/school, to my child. *

Yes

My Child's Name *

My child's homeroom is *

I understand that my child will be responsible for the safe transport of the SCRIP from the school to my home and certify that I have discussed the responsibilities associated with the transport of the SCRIP with my child *

I understand

Required

I further understand that I have the option of personally picking up my SCRIP orders from the school office rather than having my child transport it. *

I understand

Required

I agree that once the parish/school delivers the SCRIP to my child, the parish/school is not responsible for any SCRIP that is lost, stolen, or misplaced. I hereby waive any right of recovery that I may have against the parish/school for SCRIP which is lost, stolen, or misplaced after it is given to my child. *

I agree

Required

We choose to: *

Donate our SCRIP profit to Home & School.

Credit 80% of our SCRIP profit to next year's tuition.

We have an 8th grader. We would like to check written to the parochial high school of our choice.

I understand that if my family does not return to St. Mary's Visitation School for the 2021-2022 school year that my scrip rebate will be donated to Home & School. *

I agree

This agreement is effective for the 2020-2021 school year. Please sign/print your name. *

Send me a copy of my responses.

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