Parent/Guardian Resource Bag Request 
You may use this from to request a resource bag for any topic below. 
Each bag contains a book, activities, discussion questions, and additional information you might find helpful. 
This is not intended to diagnose or be the sole form of support/treatment for any area of concern. 
For the best interest of your child, all concerns should be discussed with the classroom teacher(s), school counselor or administrator, outside counselor, and/or the student's pediatrician. 
Email *
Your Name  *
What is the best phone number to reach you if we have questions? *
Student's Name  *
What grade is your student in currently?  *
I would like to request the following topic/resource:
*
I understand that I am responsible for returning the book and the included information no more than 14 days (2 weeks) of receiving the packet. If I do not return the packet, I will be billed the cost of the resources. 

Activity sheets and the crafts my child creates from the packet are mine to keep.
*
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Eastern Local School District. Report Abuse