Back-to-School - Carters Counselling

Back-to-School Supplies Application Form

Helping families prepare for a successful school year.

Parent/Guardian Information

Full Name

Phone Number

Mailing Address

Income

Child/Children Information

(Please complete for each child needing supplies)

Child #1

Full Name

Age

Grade Entering

School Attending

Child #2 (if applicable)

Full Name

Age

Grade Entering

School Attending

Child #3 (if applicable)

Full Name

Age

Grade Entering

School Attending

Child #4 (if applicable)

Full Name

Age

Grade Entering

School Attending

Child #5 (if applicable)

Full Name

Age

Grade Entering

School Attending

Child #6 (if applicable)

Full Name

Age

Grade Entering

School Attending

Special Notes or Request

Is there anything we should know to better support your child(ren)? (e.g., specific supply needs, allergies. etc.)

Special Notes

Consent & Agreement

. By submitting this form, I confirm that I am the legal guardian of the child(ren) listed above and understand that supplies are distributed based on need and availability.

Back-to-School Supplies Application Form

Parent/Guardian Information

Child/Children Information

Child #1

Child #2 (if applicable)

Child #3 (if applicable)

Child #4 (if applicable)

Child #5 (if applicable)

Child #6 (if applicable)

Special Notes or Request

Consent & Agreement

Availability

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