2024 Back to School Clothing Drive School Registration

Form Instructions

Enter your organization information followed by individual student data. When you Submit your data, it will be saved in the system. You may submit student data in multiple sessions.

If you are a Nonprofit or Charter school you will find your Organization under "Nonprofit or Charter School" in the School District field. For Luke AFB, enter "Luke AFB" under the district selection, and "Luke Airforce Base Community Chapel" as the school choice.

If you have any problems with this form, call Janette Lopez, Program Director at 602-256-9408, extension 1002.

School District/LAFB (Choose Nonprofit/Charter School if this is not a district school)

School/Organization Name

This is a Title 1 School

Yes

Principal / Organization Director / LAFB Family Name

Full Name

School Primary Contact Information

First Name

Last Name

Cell Phone

Chaperone 1 (Full Name) Not required for LAFB

Chaperone 2 (Full Name) Not required for LAFB

All participants agree to the following: (Must agree to all 3 items to participate):

1. This information is true and correct

2. BTSCD may use this information

3. I understand that by accepting this invitation, consent is given to BTSCD to use all images, video and audio of participants for BTSCD marketing purposes

I AgreeI Do Not Agree

Enter Student Order Information Now?

YesNo

Student Orders

Student Information

First Name

Last Name

Student Age

Gender

What is the Student's Grade at the Time of Registration?

What is the Student's Ethnicity?

On behalf of the district I am certifying that the student meets eligibility guidelines

Yes

Uniform Selection

If appropriate, please select the color for the uniform top

If appropriate, please select the size for the uniform top

If appropriate, please select the color for the uniform bottom

If appropriate, please select the size for the uniform bottom

If none selected, child will receive Navy Blue top and Khaki bottoms. Size exchanges will need to be made by exchanging through your school clothing closet.

Parent/Guardian Information

First Name	Last Name
Email	Parent/Guardian Phone
City	Zip Code

All children receive oral health education. Opt-In children receive a dental screening and fluoride varnish application, valued at $80

This child has permission to participate in a dental screening during the event.

YesNo

Review all information for this student to confirm data is correct before you continue, or you will not be able to submit your registrations.

Special Instructions

Please Select a Pickup Timeslot

By typing your name here, you certify that all registered students qualify under federal guidelines for income:

Contact Information