Crutches 4 Kids: Crutch Drive Registration Form
Thank you for hosting a crutch drive for Crutches 4 Kids! Every crutch collected will transform a child's life, enabling them to move beyond their boundaries with safety, mobility and comfort. To register your drive with Crutches 4 Kids, please complete this form.

**Please note transportation for the collected crutches must be coordinated before the drive begins.

Please provide your name *
Your answer
Please provide your email address *
Your answer
Please provide your telephone number
Your answer
Please provide your address *
Your answer
When will you be holding your crutch drive and for how long? *
Start and end dates, along with drop-off hours.
Your answer
Where will you be holding your crutch drive? *
Please provide the address of all crutch collection locations
Your answer
Who is planning the crutch drive (individual, student group, organization, hospital, etc)?
Your answer
Describe how you plan to advertise and promote the crutch drive (flyers, emails, events, etc)
Your answer
How do you plan to transport the crutches collected during your drive? *
Your answer
Where do you plan to deliver the crutches collected during your drive? *
Your answer
Do you authorize the public release of pictures of the crutch drive, as well as the crutch drive date and coordinator contact information on our website and social networking sites (include coordinator contact information if different than above)? *
Are you under the age of 13? *
If so, please have your parent or guardian send his/her permission to organize the crutch drive to info@crutches4kids.org
Required
Are you planning a school crutch drive? *
If you are planning a school crutch drive, you must have your school's permission. Please have a school official send permission to info@crutches4kids.org.
If you are planning a school crutch drive, please provide, in the space below, the name of your school, type (public or private), telephone number, address, and name and contact information of the teacher supervising the crutch drive
Your answer
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