Request for Pick-Up BLK 2024
  • This form is to submit a request to have volunteers select winter-wear for your child based on the information you provide below. After the request is filled, BLK will contact you by email to coordinate for you to pick-up at the BLK office by appointment at 126 S Chestnut St, Ellsworth, WI.
  • If you prefer to schedule your child to "shop" at our BLK office in Ellsworth, please use the appropriate online registration form at www.BasicsForLocalKids.org...not this form.
  • One form for EACH child.
  • Kids ages newborn through 18 years old living in western Wisconsin are eligible.
  • Selection variety is based on donations. We do our best, but can not guarantee availability.
  • Please be patient. Our BLK team has all unpaid volunteers who also keep busy with jobs and families. We look forward to helping your child stay warm and active outdoors this winter.
  • This form is a bit more detailed so we can do our best with the provided information to select items that will fit your child.
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Email *
Name of Child: First and Last name *
City/Town child lives in *
County child lives in *
Age *
Gender (this just helps volunteers know where to start to pull items) *
Child's FAVORITE color, sports team, school mascot, etc.
Clothing colors, sports teams to AVOID:
Helpful notes for filling requests: (girly, female fit-not girly, traditional boy colors, husky, slim, taller, shorter, special needs i.e. velcro boot for braces, etc.)
Coat/Jacket size
 *
Snow pants size. (Note: Most adult snow pants are unisex/men's fit and typically run larger and longer. Please specify in notes above if you prefer woman's fit if in stock.) *
Boot size (Note: most of our boots are available in whole sizes only, not half sizes.)
 *
Gloves: (OR select mitten size in next question) *
Mittens: (OR select gloves size in previous question) *
Hat *
Scarf *
Socks: (we will select size based on boot size listed above) *
Volunteer will email or call you when items are ready for pick-up. You may enter your cell# here if you choose.
Pick-up is at BLK, 126 S Chestnut, Ellsworth, WI
Parent/Guardian Name *
Contact email: *
A copy of your responses will be emailed to the address you provided.
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