BACK-TO-SCHOOL STUDENT REGISTRATION
Please complete all required information.
PICK-UP DATES: AUGUST 25TH-28TH
Pick up will range from the 25th to the 28th.
1 STUDENT INFORMATION
Student Full Name:
First Name
Last Name
Parent/Guardian Name:
First Name
Last Name
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
School Name:
Grade Level:
Student Gender:
Boy
Girl
2 JACKET REQUEST
Jacket Needed?
Yes
No
Jacket Size:
Jackets are limited and based on availability.
3 BACKPACK REQUEST
Backpack Needed?
Yes
No
Backpacks are limited and based on availability.
4 SCHOOL SUPPLY REQUEST
Requesting Full School Supplies?
Yes
No
School Supply List Attached?
Yes
No
To receive full school supplies, you must provide the student's official school supply list. Requests without a school supply list will be considered incomplete.
PARENT/GUARDIAN CONFIRMATION
I confirm that the information provided is accurate and understand that jackets, backpacks, and school supplies are limited and based on availability.
Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preview PDF
Submit
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