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Registration for Kids to "Shop" at BLK office 2024
This form is to register a child to "shop" at the BLK office in Ellsworth, WI
by appointment
to pick-out needed winter-wear.
After submitting this form, go back to the BLK website to schedule the appointment for each child to shop
.
One form for EACH child.
Kids ages newborn through 18 years old living in western Wisconsin are eligible.
If you prefer to have volunteers pick out the requested winter-wear items for you to pick-up in Ellsworth;
please use the OPTION B request form at
www.BasicsForLocalKids.org
...not this form
.
Selection variety is based on donations. We do our best, but can not guarantee availability.
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* Indicates required question
Email
*
Your email
Name of Child: First and Last name
*
Your answer
City/Town child lives in
*
Your answer
County child lives in
*
Pierce County, WI
St. Croix County, WI
Other
Age
*
Your answer
Coat/Jacket Size (type N/A if not needed)
*
Your answer
Snow pants size (type N/A if not needed)
*
Your answer
Boot size (type N/A if not needed)
*
Your answer
Gloves/Mittens/Hat (type N/A if not needed)
*
Your answer
Parent / Guardian name
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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