Child Distribution Waiver
Please return with your 1st order only OLPH students only If you choose to have your SCRIP order sent home with your student at any time during the year, please indicate student’s name, grade and homeroom. ______________________ Grade/Homeroom
_____________________ Student
Waiver of responsibility: I acknowledge that the OLPH Scrip Program and OLPH Home and School Association will not accept responsibility for the SCRIP order once it is released to my child. _______________________________________ ________ Signature Date
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