BackPack Request Form

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Rock in the Pocket will be giving away 100 free backpacks this year. Backpacks will also include, 2 notebooks, wide ruled paper, and pencils to assist with required school supplies this year. Please complete this form to request your backpack(s).

Back packs will be available for pick-up at Birney Elementary School on July 30th from 11am-12pm.We are not permitted to be on-site after that time so please be on time as you can just drive-up and receive your backpack.

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Parent's Name *

Your answer

Parent's Email Address *

Your answer

How many kids are you requesting a backpack(s) for? *

1

2

3

Child's School (Optional)

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