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Case Workers/School Staff BLK Request Form 2024
Hello! Please note that we do not have the volunteer power to deliver to families or meet up with them like previous years,
but we ARE still offering to drop off at schools/office for case workers/staff requesting items on behalf of kids.
We also have 24/7 access available for you to pick-up at our BLK office in Ellsworth, WI if you are in the area.
October: PLEASE encourage families to go to the BLK website and register for one of the options on their own. We hope this will help us get the majority of kids taken care of sooner than later without overwhelming your workload.
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 share our website with your colleagues who help kids ages newborn thru 18 years old. Directing them to our website and telling them to go directly to the "case worker" tab at the top is most helpful.
www.BasicsForLocalKids.org
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* Indicates required question
Email
*
Your email
Case worker or staff name (first and last)
*
Your answer
Agency or school name
*
Your answer
Are you requesting on behalf of child as a:
*
Case Worker
School Staff
Other:
City/Town or School District child lives in
*
Your answer
County child lives in
*
Pierce County, WI
St. Croix County, WI
Other
Name of Child: First and Last name (or whatever can be shared to label the bag)
*
Your answer
Age
*
Your answer
Gender (this just helps volunteers pull items)
*
Boy
Girl
Child's
FAVORITE
color, sports team, school mascot, etc.
Your answer
Clothing colors, sports teams to
AVOID:
Your answer
Helpful notes for filling requests: (girly, female fit-not girly, traditional boy colors, husky, slim, taller, shorter, special needs i.e. velcro boots, etc.)
Your answer
Coat/Jacket size - type N/A if not needed.
Be sure to note Toddler, Youth, and size number.
Adults sizes use Small, Medium, Large, XL, etc.
*
Your answer
Snow pants size - type N/A if not needed
Be sure to note Toddler, Youth, and size number.
Adults sizes use Small, Medium, Large, XL, etc.
*
Your answer
Boot size
*
Choose
Not Needed
Toddler 5
Toddler 6
Toddler 7
Youth 8
Youth 9
Youth 10
Youth 11
Youth 12
Youth 13
Youth 1
Youth 2
Youth 3
Youth 4
Youth/Adult 5
Youth/Adult 6
Adult 7
Adult 8
Adult 9
Adult 10
Adult 11
Adult 12
Adult 13
Adult 14
Adult 15
Gloves: (OR select mitten size in next question)
*
Choose
Not Needed
Infant
Toddler
Youth Small
Youth Medium
Youth Large/XL
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Mittens: (OR select gloves size in previous question)
*
Choose
Not Needed
Infant
Toddler
Youth Small/Medium
Youth Large/XL
Adult Small/Medium
Adult Large/XL
Adult XXL
Hat
*
Choose
Not Needed
Infant
Toddler
Youth
Adult Small/Medium
Adult Large/XL
Scarf
*
Yes (if we have any)
No
Socks: (we will select size based on boot size listed above)
*
Yes, black socks in boy/mens style
Yes, white or multi-color socks in girl/womens style
Not Needed
Additional wish requests if we have any on hand: (i.e. blankets, fall/spring jackets, clothes, shoes, backpack, school supplies, etc. List requested items and details/sizes.)
Your answer
Delivery / Pick-up Options:
Pick-up (24/7 availability) at BLK, 126 S Chestnut, Ellsworth, WI
OR Request volunteer to drop off at the school (name and city)
OR Request to coordinate meet up/drop off with case worker
*
Your answer
Contact email:
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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