Complete this form to register for the Backpack/School Supplies Give-a-way. You can also download and print a registration form by clicking here.

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Parent/Guardian

Name (First, MI, Last)

Address:

City: State: Zipcode:

Phone: email: Yearly Income:

I am currently receiving public assistance

Parent/Guardian

Name (First, MI, Last)

Address:

City: State: Zipcode:

Phone: email: Yearly Income:

I am currently receiving public assistance


Child(ren)

Name (First, Last)	School: A. S. Rhodes Warren County Middle E. W. Morrison Skyline Hilda J. Barbour Warren County High Leslie Fox Keyser Blue Ridge Technical Ressie Jeffries Mountain Vista	Grade: K 1 2 3 4 5 6 7 8 9 10 11 12	Gender: M F
Name (First, Last):	School: A. S. Rhodes Warren County Middle E. W. Morrison Skyline Hilda J. Barbour Warren County High Leslie Fox Keyser Blue Ridge Technical Ressie Jeffries Mountain Vista	Grade: K 1 2 3 4 5 6 7 8 9 10 11 12	Gender: M F
Name (First, Last):	School: A. S. Rhodes Warren County Middle E. W. Morrison Skyline Hilda J. Barbour Warren County High Leslie Fox Keyser Blue Ridge Technical Ressie Jeffries Mountain Vista	Grade: K 1 2 3 4 5 6 7 8 9 10 11 12	Gender: M F

 

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Although we are requesting this information, it is not used to determine eligibility.

 

What church do you attend? How often/yr? 0-10 11-20 21-30


Please contact me for these events (check the events of interest):

Resume Writing	Clothing give-a-way	CPR Training
Interviewing Techniques	Financial Counseling	Youth Events
Bookbag/Supplies give-a-way	Addictions	Newsletters
Men's Events	Women's Events

How can VBC pray for you and your family?