Neighbors Helping Neighbors
Please answer the questions below to reserve a time slot to pick up items for your family.  If you need to cancel or change your time slot after submitting, please call 419-335-3686.

Responda las preguntas a continuación para reservar un horario para recoger artículos para su familia. Si necesita cancelar o cambiar su franja horaria después de enviarla, llame al 419-335-3686.
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Full Name (Nombre) *
Contact Number (Número de contacto) *
Street/Mailing Address (Dirección) *
City/State/Zip (Ciudad) *
What is the primary language spoken in your home?  (¿Cuál es el idioma principal que se habla en su hogar?)
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How many children in grades K-8 are in your household? (¿Cuántos niños en los grados K-8 en su casa?) *
How many children in grades 9-12 are in your household? (¿Cuántos niños en los grados 9-12 en su casa?) *
What school district do you attend? (¿A qué distrito escolar asiste?) *
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