Backpack Requests for Students

Childs Last Name

Childs First Name

Phone Number

Grade for 2026-2027 Year

Child's age

This request is for my child and they will be in attendance at the event.

Yes

Are you receiving assistance from any other back-to-school programs?

Yes

School District child will be attending?

School Name

Parent's First and Last Name?

How did you hear about us?

I'm requesting help with...

I understand this form is for ONE child. If I have multiple children, additional forms needs to be filled out.

Yes

Any additional comments, concerns or special circumstances?

Privacy Notice: All information provided will be kept confidential and used only for the purpose of this program. We are committed to protecting your privacy and will not share your information.

I understand and agree to the privacy policy and consent to the use of this information for the Backpack Squad Program.

Photographers may be present at events and I understand my photo may be taken and shared to social media. If you are part of the Safe at Home Program, please indicate in the comments section.

Yes

Coon Rapids Distribution 2026

Aug 18, 2026, 6:00 PM – 8:00 PMLocation is TBD