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Please print this page, and mail or fax the completed form to:
PACE T.R.I.P.
Grand Rapids Christian Middle School
1812 Sylvan Ave SE 49506
Grand Rapids, MI 49506
FAX: 616.248.0351
T.R.I.P. REGISTRATION FORM
T.R.I.P. ACCOUNT # ______________________________________________________________
(Leave this blank, we will contact you with your account number after we process this form)
FATHER’S NAME _____________________________________________________________
MOTHER’S NAME _____________________________________________________________
ADDRESS _____________________________________________________________________
CITY _______________________________ ZIP ___________ PHONE _____________________
DIRECT MY REBATES TO:
T.R.I.P. rebates can be split between accounts. If you would like your rebates to go to more than one account please indicate each name and account number and percentage you would like each to receive.
[ ] MY PERSONAL TUITION ACCOUNT
[ ] NAME ___________________________________ ACCOUNT # _______________ % ____________
[ ] NAME ___________________________________ ACCOUNT # _______________ % ____________
[ ] NAME ___________________________________ ACCOUNT # _______________ % ____________
[ ] _______________________________________________ CHURCH CHRISTIAN ED. FUND
[ ] G.R.C.S. GENERAL TUITION ASSISTANCE ACCOUNT % _________________
[ ] E.C.C.E.S. % ___________________
[ ] ANONYMOUS (CHECK IF YOU WOULD LIKE YOUR DONATION TO BE ANONYMOUS)
CERTIFIATES WILL BE ORDERED AND PICKED UP AT:
[ ] CHRISTIAN HIGH [ ] CRESTON/EVERGREEN [ ] MILLBROOK
[ ] MIDDLE SCHOOL [ ] OAKDALE [ ] ROCKFORD [ ] TRIP OFFICE
DISCLAIMER:
COMPLETE THIS SECTION IF YOUR CERTIFICATES WILL BE SENT WITH A STUDENT OR MAILED HOME.
I (WE) AUTHORIZE THE T.R.I.P. COMMITTEE TO RELEASE MY T.R.I.P. CERTIFICATES TO MY CHILD, OR TO MAIL THEM IF I PROVIDE A SELF ADDRESSED STAMPED ENVELOPE. I WILL NOT HOLD P.A.C.E.T.R.I.P., G.R.C.S. OR THE T.R.I.P. COMMITTEE RESPONSIBLE FOR ANY LOST CERTIFICATES,
CHILD’S NAME _____________________________ GRADE _____ TEACHER _________________________
SIGNATURE ________________________________________________________ DATE _______________
I (WE) UNDERSTAND AND WILL ABIDE BY THE GENERAL POLICIES OF THE T.R.I.P. PROGRAM.
SIGNATURE _____________________________________________________ DATE _______________
IF YOU HAVE ANY QUESTIONS PLEASE CALL THE T.R.I.P. OFFICE AT 574-6347
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