Registration for Kids to "Shop" at BLK office 2025
  • 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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Email *
Name of Child: First and Last name *
City/Town child lives in *
County child lives in *
Age *
Coat/Jacket Size (type N/A if not needed) *
Snow pants size (type N/A if not needed)

 *
Boot size (type N/A if not needed)
 *
Gloves/Mittens/Hat (type N/A if not needed)
Parent / Guardian name *
Phone# *
A copy of your responses will be emailed to the address you provided.
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