Care Closet Request Form

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Please complete this form to request items for your family. Once the request has been packed, you will be notified to pick it up in the front office. All students who attend Pivot Charter School and their Parents/Guardians may request items. No questions will be asked. Names will be used for pick-up only and will not be stored.

Student Name *

Parent/Guardian Name

Phone Number/email *

Which items do you need? (check all that apply)

Food Items

Shampoo

Conditioner

Brush

Comb

Soap

Feminine Hygiene Products - Tampons

Feminine Hygiene Products - Pads

Deodorant - Masculine Scent

Deodorant - Feminine Scent

Toothbrush

Toothpaste

Lotion

(Optional):

Is there anything else you need that is not listed above?

(Optional):

Is there anything you want us to know? (examples include ages of those in need, how many people, etc.)

Submit

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