H.O.P.E Bags application

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Please complete if you would like to receive H.O.P.E bags this school year:) Those who complete the application will be put into a raffle to win a gift card!

Email *

Record my email address with my response

Student's name *

Classroom teacher *

Address *

Date of birth *

YYYY

Phone number *

Parent/guardian name *

Checking this box serves as your signature for the completion of this form *

Signature

Required

Waiver Liability: I (we) wish to participate in the H.O.P.E Pack Program, and I (we) agree to abide by the guidelines of the program. I (we) understand that the program is administered by the H.O.P.E Pack Committee and is not an official program of the Pickerington Local School District. Therefore, I (we) will not hold Pickerington Schools resonsible for any liability issues that might occur in the H.O.P.E Packs Program *

Checking this box means you understand and agree to the statement above.

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