Family Registration Form
All information on this form must be complete and accurate.
You MUST complete one form per student.
Please make sure you leave a valid email address and a good phone number in case there's a question regarding your application.
If you do not qualify for supplies, then you will receive a denial letter from our agency. Reasons you may be denied: significantly over poverty level, child does not live in Callaway County, child does not attend a Callaway County School.
Backpacks and supplies must be picked up at SERVE, Inc. on July 28th or 29th.
The supplies your child will receive from SERVE, Inc. will only be a portion of what your child is expected to bring based on the school supply list provided by their school. Parents/ guardians are responsible for providing the remaining supplies.
All children receiving supplies must be a Callaway County resident attending a Callaway County School in grades Pre-K through 12.
Parent/ Guardian Date of Birth
Total Family Household Income per month (include all income sources from any member in the home, as well as any government assistance, child support, etc.)
How many TOTAL individuals live in your household?
How many total STUDENTS are you requesting school supplies for? (REMINDER THAT YOU MUST COMPLETE A SEPARATE FORM PER STUDENT)
Child's First Name
Child's Last Name
Date of Birth
Prefer Not to Say
Two or More Races
Prefer Not to Say
Fulton- Bartley Elementary
Fulton- Bush Elementary
Fulton- McIntire Elementary
Fulton Middle School
Fulton High School
Holts Summit- JCPS North Elementary
Holts Summit- JCPS Callaway Hills
Holts Summit- JC Early Childhood
Kingdom Christian Academy
New Bloomfield Preschool
New Bloomfield Elementary
New Bloomfield Middle/ High School
North Callaway Elementary
North Callaway High School
North Callaway Middle School
North Callaway- Thunderbird Learning Center
South Callaway Early Childhood (Pre-K-2)
South Callaway Elementary (3-5)
South Callaway Middle School
South Callaway High School
St. Peter Catholic School
Grade Entering in Fall
Two Favorite Colors
(to be used when determining backpack colors):
(May be used in addition to colors if items are available. Ex: baseballs, unicorns, spiderman, basketball, etc)
Does this child need a new backpack?
Does this child need school shoes?
What is their shoe size? Please be SPECIFIC.
While we cannot guarantee that shoes will be available in your child's size, we will pass this request on to our shoe pantry partners. If they are able to find a pair that will work for your child, they will contact you at the phone number you've put on this form.
Should be Empty: