Back-to-School 2013 Backpack Registration

Last year, we distributed nearly 10,000 backpacks throughout Senate District 19. This year, we are looking forward to having you join us at one of the upcoming Back-to-School and Health Fairs scheduled around the district where we will once again distribute backpacks and school supplies.

We ask that you please complete the form below, with your request for the number of backpacks needed for your children (Kindergarten - 8th). One form per family is required. Please print and bring this form with you. We ask that all children be present to pick up their backpack and we can only distribute one backpack per child.
 

Example: newspaper, email, web site, word of mouth, radio, TV, etc.

Backpacks are being provided for children K-8th grade and we ask that each child be present to receive the backpacks and associated school supplies.

What school does your child attend? If you are registering for more than one child, list all school that your children attend.