COACHES/TEAM SPONSORS/TEACHERS 

KROGER/THORNTON CARD REIMBURSEMENT REQUESTS

The NOMS Booster Club is in charge of the Kroger and Thornton Card Fund raising programs at NOMS. 

This is information regarding the student reimbursement request for extra curricular activity fees you may be receiving.  At the bottom of the page is an example of the form. 

The steps to receive reimbursement from the booster club is as follows:

1 Please hold all requests received until the deadline date for payment.

2 Track the amounts the students are requesting for you records and to  

   determine if a balance is due from the student.

3 Place all the reimbursement requests in the booster club mailbox at

   NOMS .

4 The Booster Club will confirm the student has the amount requested

   available.  Any discrepancies will be reported.

5 A check will be written to NOMS with a breakdown of the student and

   activity to receive credit.

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North Oldham Middle School Booster Club

Kroger/Thorntons Gift Card

Reimbursement Request Form

DATE: ____________________

ORGANIZATION/SPORT: ________________________________________________

Total Amount of Request: $______________________________________________

Make check payable to: _________________________________________________

STUDENT NAME: ______________________________________________________

                                    PLEASE PRINT

PARENT NAME:________________________________________________________

                                 PLEASE PRINT

PARENT PHONE NUMBER: ______________________________________________

PARENT SIGNATURE: __________________________________________________

For current balances available call Melissa Horn, Treasurer 228-9969

NOMS Booster Club Treasurer to complete:

Amount available in Kroger Program: $_______________________________________

Amount available in Thorntons Program: $____________________________________

Amount Reimbursed: $___________________________________________________

Check Number: #________________________________________________________

Check Date: ___________________________________________________________

Approved by: ___________________________________________________________