Get FIRED Up Registration
Parent Name
*
First Name
Last Name
Will your child(ren) need a backpack/school supplies?
*
Yes
No
What School District do your children attend?
*
If yes, how many children will be receiving backpacks/supplies?
How many total people in your family will attend?
*
Answer the Following Questions for Backpacks/School Supplies ONLY
Child 1 Name:
First Name
Last Name
Child 1 Grade:
Pre-K
K-2
3-5
6-8 (MS)
9-12 (HS)
Child 2 Name:
First Name
Last Name
Child 2 Grade:
Pre-K
K-2
3-5
6-8 (MS)
9-12 (HS)
Child 3 Name:
First Name
Last Name
Child 3 Grade:
Pre-K
K-2
3-5
6-8 (MS)
9-12 (HS)
Child 4 Name:
First Name
Last Name
Child 4 Grade:
Pre-K
K-2
3-5
6-8 (MS)
9-12 (HS)
Child 5 Name:
First Name
Last Name
Child 5 Grade:
Pre-K
K-2
3-5
6-8 (MS)
9-12 (HS)
Please Note!!! You and your child(ren) must attend Get FIRED Up on August 17 at the Monessen HS, 5 pm, to receive a backpack and/or school supplies! We cannot hold them for anyone. This is the same every year. By signing this form, you acknowledge that you need to attend to receive these items. If any remain at the conclusion, they will be given to any unregistered children in attendance. Families involved in Monessen Family Center programming and attend Monessen School District are given priority, but we will take registration on a first come, first served basis.
Signature
*
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