2021 Winter-Wear Request Form

BLK Winter-Wear Request Form 2021
(One child per form)

BLK offers free winter-wear to kids in need ages newborn through 18 years old in living in Pierce or St Croix counties in western Wisconsin.

The distribution process includes this on-line form submittal, and pickup/delivery options. We will contact you when items are ready. Our goal is to fill requests as inventory allows within two weeks of submitting. You may follow up after two weeks if you haven't heard from us.
Child's Name *

First Name Last Name
Child Clothing Info: Boy or Girl *
Child's Age *
County Child Lives In *
If outside of Pierce or St Croix County, provide name of County.
Child's Grade in School *
School District Child Lives In *
Child's Favorite Colors
Colors to Avoid
Child's Shape (optional: helpful with fulfilling requests)
Coat/Jacket Size
Snow Pants Size
Boot Size
Does the child need a hat?
Does the child need a scarf?
Glove Size
Requestor Contact Info
Requestor's Name *

First Name Last Name
Address *
Phone Number *

Area Code Phone Number
Email
example@example.com
Drop-off or Pick-up? You will be notified when items are ready. Pick-up will be by appointment at the BLK office located in Ellsworth. We also have weekly meet up locations in both counties. *
Other Information/Message
Should be Empty:

Requestor Contact Info