2022 Back-to-School
Family Registration Form
FORM INSTRUCTIONS:
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
*
First Name
Last Name
Parent/ Guardian Date of Birth
-
Month
-
Day
Year
Date
Phone Number
*
-
Area Code
Phone Number
Email Address
*
example@example.com
Home Address
*
City
*
State
*
Missouri
Zip Code
*
County
*
Callaway
Other
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)
*
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Student Information
Student Name
*
Child's First Name
Child's Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Prefer Not to Say
Ethnicity
*
African-American
Alaskan Native
American Indian
Asian
Caucasian
Middle Eastern
Native Hawaiian
Pacific Islander
Two or More Races
Prefer Not to Say
School
*
Fulton- FECC
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
Home School
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
*
Preschool
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Two Favorite Colors
*
(to be used when determining backpack colors):
Special Interests
*
(May be used in addition to colors if items are available. Ex: baseballs, unicorns, spiderman, basketball, etc)
Does this child need a new backpack?
*
Yes
No
Does this child need school shoes?
*
Yes
No
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.
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Should be Empty: