Back to School Form

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Back to School Form

Complete this form to sign up for a backpack filled with school supplies from Free the Need. Please note that submitting this form does not guarantee you a backpack or school supplies. We do our best to accommodate everybody. You will receive an email soon to confirm with details for the distribution.

What town do you live in?

What location do you want to pick up the school supplies in? *

Klamath River

Yreka

What is your name? *

We will not share your information with anyone. We just need a name to be able to check you in when you come to pick up school supplies.

What is your phone number? *

What is your email address? *

How many children would you like school supplies for? *

Child #1 Gender *

Male

Female

Prefer not to say

Child #1 Age *

Child #2 Gender

Male

Female

Prefer not to say

Clear selection

Child #2 Age

Child #3 Gender

Male

Female

Prefer not to say

Clear selection

Child #3 Age

Child #4 Gender

Male

Female

Prefer not to say

Clear selection

Child #4 Age

Child #5 Gender

Male

Female

Prefer not to say

Clear selection

Child #5 Age

Child #6 Gender

Male

Female

Prefer not to say

Clear selection

Child #6 Age

Child #7 Gender

Male

Female

Prefer not to say

Clear selection

Child #7 Age

Child #8 Gender

Male

Female

Prefer not to say

Clear selection

Child #8 Age

Submit

Clear form

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