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Parent/Caregiver First Name*
Parent/Caregiver Last Name*
Primary Email*
We need an email address to be able to contact you and provide information.
Primary Phone Number*
Enter Int'l Number
Number of Legal Guardianship Children in Home
Number of Adoptive Children in Home
Number of Foster Children in Home
FAC Location*  
Back to School Children  
This section below must be filled out. Please select the number of children needing backpacks using the drop down list. **If your child is in kindergarten select 0 for grade.
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