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Client Sign-Up

Items needed for back to school will be donated by a family who will shop specifically for your children. Please fill out the form below if you are in need of back to school supplies.

First Name

Last Name

Address

City

Zip Code

Phone Number

Email

Please select the agency that referred you

Please select how many children you would like to sign-up

Child 1 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up

Shirt

Pant

Shoe

Child 2 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up

Shirt

Pant

Shoe

Child 3 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up

Shirt

Pant

Shoe

Child 4 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up

Shirt

Pant

Shoe

Child 5 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up

Shirt

Pant

Shoe

Child 6 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up

Shirt

Pant

Shoe

Child 7 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up

Shirt

Pant

Shoe

Child 8 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up

Shirt

Pant

Shoe

Child 9 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up

Shirt

Pant

Shoe

Child 10 Information

Name

Age

Gender

Grade

What is the name of the school your child attends?

Please tell us about your child's clothing and shoe sizes

When in doubt, it is recommended to size up