FREE PEP Winter Coat Registration 2021                                                    ALL children MUST be present when receiving COATS! This is a Requirement!
Parents Engaging Parents Inc.(PEP) will distribute 5000 coats to low-income students in 5 to 7 communities across New Jersey to families from the PEP Statewide database. Distribution will commence in November through early December to ensure children have their coats for cold weather.  COATS, FACE COVERINGS and resources to young children and their families will be distributed following safety guidelines by the parents, community leaders and local non-profit partners during the COVID-19 pandemic.
( All children MUST be present when receiving COATS. NO EXCEPTIONS)
PRE-REGISTERED FAMILIES ATTEND EVENT WITHIN FIRST HOUR FOR PREREGISTERED COATS

To continue this work please donate to https://www.paypal.me/ITAVPEPINC. Your dollar counts!
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Name *
Last NAme
Phone Number *
Address *
City *
email *
Which of these NJ Counties do you reside in, and would like to register for a Free New Winter coat for your child/children? Burlington and Hudson County Pre-registration is NO LONGER Available, and has been completed. *
How any children are in the household *
Please give FULL name of each child and Date of Birth, separate each name by comma Requirement) *
Please give the age(s) of child/children
1
2
3
4
5
6
7
8
10
11
12
13
14
15
16
17
18(with school ID)
19(with school ID)
20(with school ID)
21(with school ID)
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8
Child 9
Child 10
Clear selection
Please give birth month and year of each child receiving a coat.
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Jan
Feb
March
April
May
June
July
Aug
Sept
Oct
Nov
Dec
Clear selection
Please give coat size of each child, (COATS RUN SMALL, remember all children MUST be present when receiving COATS, this is a Requirement)
Boys Size 2t
Boys Size 3t
Boys Size 4t
Boys Size 5/6
Boys Size 7/8
Boys Size 10/12
Boys Size 14/16
Boys Size 18
Girls Size 2t
Girls Size 3t
Girls Size 4t
Girls Size 5/6
Girls Size 7/8
Girls Size 10/12
Girls Size 14/16
Girls Size 18
boy
girl
boy 2
girl 2
Boy 3
girl 3
boy 4
girl 4
boy 5
girl 5
Row 11
Clear selection
Is your family involved in early childhood programs? if so please list below the ones you are currently engaged with, including but not limited to, state preschool programs, Head Start, Home Visiting, SNAP, and WIC. ( Ex: Head Start, Family Success and Program for Parents) *
Will you & your family be able to Pick-Up at a location in your county?   *
Required
In weekly virtual engagements over three months, Parents Engaging Parents will actively support these 5 to 7 community's residents during this crisis by providing a safe and accessible venue to build community relationships through sharing experiences, stories, structure and actions. The weekly engagements will serve as “Mental Health Check-Ins”, by which PEP Parent Champions will discuss how the crisis has impacted them, their families and their households. PEP Parent Champions will discuss ways to promote self-wellness for the parents, and share strategies on how to better support their children, families and community during these times. Will you be interested in continuing our relationship of engagement? *
Are you interested in receiving more information about future engagements from PEP and PEP affiliates? *
PHOTO/STORY RELEASE FORM (CHILD)                                                                                     
We thank you in advance! Allowing us to capture photos and share stories is crucial to the success and expansion of this important mission.I am authorized to grant the rights provided in this Photo/Story Release Form.I WARRANT THAT I AM 18 YEARS OF AGE OR OLDER AND FULLY UNDERSTAND THE CONTENTS OF THIS RELEASE OR THAT IF I AM A MINOR, THAT MY PARENT(S) OR LEGAL GUARDIAN(S) HAVE SIGNED BELOW.
                                                                            
This Photo/Story Release Form and any disputes relating to it or the Materials shall be governed by the laws of the State of New Jersey, United States of America, and shall be resolved within the State of Pennsylvania.I as Parents Engaging Parents, anyone working for it or on its behalf, and any sub-licensees, from any and all liability, claims, and causes of action that I might have against it arising out of the recording and/or use of such Materials.
Do you grant to Parents Engaging Parents permission, with respect to the video recordings, sound recordings, film, photographs, biographical information, and/or images (collectively “Materials”) that Parents Engaging Parents and/or its agents have taken of meAll the permissions and releases that I grant shall be effective throughout the world and apply to Parents Engaging Parents and its employees, volunteers, sub-licensees, and agents?                       *
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