TRIP REGISTRATION FORM

Please print this page and return the completed form to:

PACE - TRIP
1508 Alexander St. SE, Grand Rapids, MI 49506
PHONE: 616.574.6030    FAX: 616.574.6032

TRIP ACCOUNT # ____________________________________________________(to be assigned by GRCS office)
         
PARENT NAME(S) ___________________________________________________________________________

               ___________________________________________________________________________

ADDRESS       ___________________________________________________________________________

CITY  _______________________________ ZIP  __________________ PHONE _________________________

EMAIL ADDRESS   ___________________________________________________________________________

 PLEASE DIRECT MY TRIP CREDIT TO:

_____ MY PERSONAL FAMILY TUITION ACCOUNT – 100%

If you would like your TRIP credits to be donated to one or more accounts, please indicate each name, account number,
and percentage to be received below. 

_____ OTHER FAMILY TUITION ACCOUNT (list name and account # below):

    Name ___________________________________ ACCOUNT # _______________   ______%

    Name ___________________________________ ACCOUNT # _______________   ______%

_____ CHURCH CHRISTIAN EDUCATION FUND _______________________________   ______%
                                             (Name of Church

_____ EAGLES FUND (General Tuition Assistance) - Account #169999  ____%

 _____ GR CHRISTIAN MIDDLE SCHOOL TUITION ASSISTANCE FUND - Account #253  ______%

I / WE UNDERSTAND AND AGREE TO THE POLICIES AND PROCEDURES OF THE TRIP PROGRAM

SIGNATURE __________________________________________________ DATE _____________

           __________________________________________________ DATE _____________