
________________________________ updated 25 August 2012
Parent Name (print)
______________________________________ ____________
Signature Date
Please complete below:
(ALL 12 digits)
Last Name Associated with Card: ___________________________
(ALL 12 digits)
Last Name Associated with Card: ___________________________
Food Lion MVP #:___________________________________
(ALL 12 digits)
Last Name Associated with card: _______________________________
Safeway Bonus Card #:_____________________________________
(ALL 11 digits)
Address: _______________________________ Phone number:___________________
(Both address and phone number required to enroll in Escrip program)
Additional things you can do at home to help our school:
1.Link Your Target Credit Card to our school
2.Sign up for a free boxtops4education account at www.boxtops4education.com
3.Collect My Coke Rewards points, boxtops for education, and labels for education UPC codes. Return them to school.
4.Join the PTA
