Request for Pick-Up BLK 2025
  • PLEASE READ to make sure you are choosing the option you want.
  • This form is submitting a request to have volunteers select winter-wear for your child based on the information you provide below AND you will pick up at the BLK office in Ellsworth.
    After the request is filled, BLK will contact you by email to coordinate for you to pick-up at BLK on specified dates at 126 S Chestnut St, Ellsworth, WI.
  • If you would rather schedule your child to "shop" at our BLK office in Ellsworth to select and try on winter-wear, please use the appropriate online registration form at www.BasicsForLocalKids.org...NOT THIS FORM.
  • One form for EACH child.
  • Kids ages newborn through 18 years old living in western Wisconsin are eligible.
  • Inventory is based on donations. We do our best, but can not guarantee availability.
  • This form is a bit detailed so we can do our best to select items that will fit your child.
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Email *
Name of Child: First and Last name (Nombre del niño) *
City/Town child lives in (Ciudad) *
County child lives in *
Age (Edad) *
Gender (this just helps volunteers know where to start to pull items) (Género) *
Child's FAVORITE color, sports team, school mascot, etc. (El color favorito del niño, los deportes, etc.)
Clothing colors, sports teams to AVOID (Colores de ropa, equipos deportivos a evitar):
Helpful notes for filling requests: (girly, female fit-not girly, traditional boy colors, husky, slim, taller, shorter, special needs i.e. velcro boot for braces, etc.) (Notas útiles para completar solicitudes.)
Coat/Jacket size (Abrigo)
 *
Snow pants size (Pantalónes de nieve): *
Boot size (Note: boots are available in whole sizes only, not half sizes.) (Tamaño de la bota)
 *
Gloves: (OR select mittens at the bottom of list) (guantes) *
Hat (Sombrero) *
Scarf (Bufanda) *
Socks: (sizes based on boot size listed above) (Calcetines) *
Volunteer will contact you when items are ready for pick-up. Please enter cell# here.
Pick-up is at BLK, 126 S Chestnut, Ellsworth, WI
 *
Parent/Guardian Name (Nombre del padre/tutor): *
Contact email: *
A copy of your responses will be emailed to the address you provided.
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