Back to School Event 2021 CHEMUNG COUNTY
Please complete for your family in order to be guaranteed a backpack for each child.
[Backpacks are only available for PreK-12th grade this year.]
Backpacks may be picked up at the Event: August 31, 3pm-5pm at the Elmira Economic Opportunity Program. Backpacks not picked up by 9/8 at 3:30pm will be given to other children.
Any questions, please call 607-734-9784.
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Email *
Last Name of Parent/Guardian (this is the name that all your backpacks will be listed under) *
First Name of Parent/Guardian *
Street Address *
Zip Code *
School District *
Best Phone Number to Reach You At *
When will you pick up your backpacks? Economic Opportunity Program is the location of pick-up (650 Baldwin St, Elmira) *
How will you pick up? *
Where did you hear about the Back to School Kick-off Event? *
Name of Child #1 *
Age of Child #1 *
Grade for Child #1 *
Color Preference for Child #1 (we will try our best!) *
Required
Name of Child #2
Age of Child #2
Grade for Child #2
Clear selection
Color Preference for Child #2 (we will try our best!)
Name of Child #3
Age of Child #3
Grade for Child #3
Clear selection
Color Preference for Child #3 (we will try our best!)
Name of Child #4
Age of Child #4
Grade for Child #4
Clear selection
Color Preference for Child #4 (we will try our best!)
Name of Child #5
Age of Child #5
Grade for Child #5
Clear selection
Color Preference for Child #5 (we will try our best!)
Name of Child #6
Age of Child #6
Grade for Child #6
Clear selection
Color Preference for Child #6 (we will try our best!)
Names, Ages & Grades for any additional children
Color Preferences for any additional children (we will try our best!)
A copy of your responses will be emailed to the address you provided.
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