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Curriculum Assistance Program (C.A.P.) Registration Form

indicates a required answer

1. *

Name (first and last):
2. *

Address:
3. *

Phone:
4. *

Permission to send text messages to this number:
Yes No
5. 

Work Phone:
6. *

Email:
7. *

How would you like to receive your rebate?
Check Paypal
8. *

Confirm PayPal Email:
9. *

WAIVER: We authorize the Curriculum Assistance Program volunteers of CHESS to release our gift certificate order to another designated adult to be delivered to us. We will not hold CHESS or the Curriculum Assistance program volunteers liable for any lost, stolen, misplaced, or damaged gift certificates as a result of the actions of another designated adult.

 (1 required)
I have read and understand the waiver above.