2026 Day4Hope Event Registration Form

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2026 Registration

Please fill out a complete form for each child before submitting to register for the event.
How did you hear about Day4Hope?
Saturday, August 8, 2026

Supply Elementary School - 51 Benton Rd SE, Supply, NC 28462
2026 Children's services available for free

Backpacks'; Bibles and Blessings; Books; Dental Exams; Gift Cards; Haircuts; Hearing Exams; Hygiene bags; Pillows & Pillow Cases; Shoes & Socks; Medical Exams; Vision Exams; as well as Breakfast/Lunch & more
Parent/Guardian Information:
Please select an available arrival time for the Day4Hope event.
First Name
Last Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Format: (000) 000-0000.
Email
Preferred Language
1st Child's Information:
1st Child's Name

First NameLast Name
(1) School Grade Fall 2026
K, 1-12
Approved
(1) School Name
Paper Form
(1) Child's Gender
(1) Child's Age
Services requiring sign-up

Select all that apply - Medical requires Hearing and Vision to be completed first
(1) Medical Exam (Includes sign-up for Hearing and Vision Screenings)
(1) Birth Date (Required for Medical Exam)

MonthDayYear
(1) Dental Screening
(1) Haircut
(1) Hearing Screening (without Medical)
(1) Vision Screening (without Medical)
- 2nd Child's Name
  
  First NameLast Name
- (2) School Grade Fall 2026
  K, 1-12
- (2) School Name
- (2) Child's Gender
- (2) Child's Age
- Services requiring sign-up
  
  Select all that apply - Medical requires Hearing and Vision to be completed first
- (2) Medical Exam (Includes sign-up for Hearing and Vision Screenings)
- (2) Birth Date (Required for Medical Exam)
  
  MonthDayYear
- (2) Dental Screening
- (2) Haircut
- (2) Hearing Screening (without Medical)
- (2) Vision Screening (without Medical)
- 3rd Child's Name
  
  First NameLast Name
- (3) School Grade Fall 2026
  K, 1-12
- (3) School Name
- (3) Child's Gender
- (3) Child's Age
- Services requiring sign-up
  
  Select all that apply - Medical requires Hearing and Vision to be completed first
- (3) Medical Exam (Includes sign-up for Hearing and Vision Screenings)
- (3) Birth Date (Required for Medical Exam)
  
  MonthDayYear
- (3) Dental Screening
- (3) Haircut
- (3) Hearing Screening (without Medical)
- (3) Vision Screening (without Medical)
- 4th Child's Name
  
  First NameLast Name
- (4) School Grade Fall 2026
  K, 1-12
- (4) School Name
- (4) Child's Gender
- (4) Child's Age
- Services requiring sign-up
  
  Select all that apply - Medical requires Hearing and Vision to be completed first
- (4) Medical Exam (Includes sign-up for Hearing and Vision Screenings)
- (4) Birth Date (Required for Medical Exam)
  
  MonthDayYear
- (4) Dental Screening
- (4) Haircut
- (4) Hearing Screening (without Medical)
- (4) Vision Screening (without Medical)
- Please verify that you are human
- Attended
- Should be Empty:

2026 Registration

Saturday, August 8, 2026

2026 Children's services available for free

Parent/Guardian Information:

1st Child's Information:

Services requiring sign-up

Services requiring sign-up

Services requiring sign-up

Services requiring sign-up