Language
English (US)
Spanish (Latin America)
Appointment Time
*
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
May we send an automatic text reminder?
*
Yes
No
Do you speak English?
*
Yes
No
What school does your child / Children attend?
*
Please Select
Manteo Elementary
First Flight Elementary
Nags Head Elementary
Kitty Hawk Elementary
Cape Hatteras Elementary
How many elementary aged children need an appointment?
*
Please Select
1
2
3
4
(If more than four, please make another appointment for the following time)
Child 1
Gender
*
Please Select
Male
Female
Grade Level
*
Please Select
Pre K
K
1st
2nd
3rd
4th
5th
Size
*
Please Select
4-5
6-7
8-10
12-14
16+
Shoe Size
*
Please Select
11
12
13
1
2
3
4
5
6
7
8
9
10
We are working towards building shoe inventory and will try to accommodate those with a significant need.
Child 2
Gender
Please Select
Male
Female
Grade Level
Please Select
Pre K
K
1st
2nd
3rd
4th
5th
Size
Please Select
4-5
6-7
8-10
12-14
16+
Shoe Size
*
Please Select
11
12
13
1
2
3
4
5
6
7
8
9
10
We are working towards building shoe inventory and will try to accommodate those with a significant need.
Child 3
Gender
Please Select
Male
Female
Grade Level
Please Select
Pre K
K
1st
2nd
3rd
4th
5th
Size
Please Select
4-5
6-7
8-10
12-14
16+
Shoe Size
*
Please Select
11
12
13
1
2
3
4
5
6
7
8
9
10
We are working towards building shoe inventory and will try to accommodate those with a significant need.
Child 4
Gender
Please Select
Male
Female
Grade Level
Please Select
Pre K
K
1st
2nd
3rd
4th
5th
Size
Please Select
4-5
6-7
8-10
12-14
16+
Shoe Size
*
Please Select
11
12
13
1
2
3
4
5
6
7
8
9
10
We are working towards building shoe inventory and will try to accommodate those with a significant need.
Submit
Should be Empty: