*** Note - Please read this information in it's entirety. Not filling out the form correctly could cause your request for backpacks to be delayed. Any request with missing contact information will be removed and not filled.
Please fill in the following information. Some items are required in order for you to submit the form. Please supply us with as much information as you can. We will only use this information for tracking purposes to verify where the backpacks are distributed. Please only request a backpack because you need it, not because it is free. We have many children to supply backpacks too and the ones that you request that you do not need are the ones that could delay a child in need from receiving one.
We are currently distributing in Bradford, Cameron, Lycoming, McKean, Potter, and Tioga Counties. If you do not live in one of those Counties please do not submit a request. We do not ship backpacks.
*** Please note...if you request a backpack or backpacks, you are responsible to arrange to pick them up. We cannot deliver all the backpacks requested when we receive over 500 requests. We work solely from donations and Volunteers so not only is there costs involved with delivering all the backpacks there is a large amount of time involved. We are working on getting Backpack Liaisons in as many areas as we can to get the backpacks as close as possible. It will still be your responsibility to get them picked up from there...our Liaisons will not be delivering to your home.
Sign in to Google
to save your progress.
Page 1 of 4
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service