SCRIP Registration Header

Fox Valley Lutheran High School (“FVL”) sponsors a SCRIP program which allows the purchase of gift or shopping cards from various merchants and generates rebates from those merchants. The rebates can be used as a credit to your high school tuition, a donation to the school, or cash back. Please indicate your choice concerning the use of your rebate. The rebates that you generate will be distributed annually in June. The SCRIP year runs from June 1 through May 31.

Annual statements will be provided to Parent/Guardian in late June of each year. Charitable contributions will be acknowledged pursuant to sections 170(f)(8) and 170(f)(17) of the Internal Revenue Code.

SCRIP Purchaser's Information


Do you already have a ShopWithScrip account from another Scrip program and want to use the same log in. If your email is already used in another program, FVL scrip will not be able to fully set up your account and you will be notified by email of your options. *
Primary Phone is . . . *
Secondary Phone is . . .



Please select one of the following options for your portion of the rebate *


Designated Student(s) to receive SCRIP credit

Please input students in order of graduation, listing the oldest student first.  If you wish to split your credits between two or more students/families at the same time, please explain in the comment section at the end of this form.
If NOT the parent, please list your relationship to the student in the comment box at the end of this form.
If NOT the parent, please list your relationship to the student in the comment box at the end of this form.

If NOT the parent, please list your relationship to the student in the comment box at the end of this form.

If NOT the parent, please list your relationship to the student in the comment box at the end of this form.

SCRIP Details and Required Signature


You agree to indemnify FVL against any loss incurred in connection with insufficient funds in your account to cover checks or ACH transfers you issue to pay for your SCRIP. FVL makes no representations or warranties of any kind with respect to SCRIP. This agreement continues unless replaced by another, and can be amended or terminated by either party upon 60 days’ advance notice to the other.
 
You agree that you are responsible for any NSF/bank fees resulting from paying by check.

Please sign and date below to indicate your acknowledgement of this agreement.

 +

If you have trouble with this online form, please email scrip@fvlhs.org for help.

Someone from the SCRIP Office
will be in contact with you to confirm your information.
 
Thank you for registering with the FVL SCRIP Program!