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Child's First name
*
Child's Last name
*
Email
Phone
*
Pick up Location
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Grade for 2025-2026
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Child's age
*
I'm requesting help with...
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Backpack with supplies
Backpack Only
Supplies only
Are you receiving assistance from any other back-to-school programs?
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Yes
No
School District Child will be attending
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School Name
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Parents first name
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Parents last name
*
How did you hear about us?
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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.
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