Asbury Park Backpack Drive

Thank you for registering for the 2025 Asbury Park Backpack Program. Please enter each child who needs school supplies on the form, as we want to make sure we are providing the correct supplies for their grade.

Backpacks will be distributed at Community Day to be held on August 23 from 1 PM to 5 PM at St. Stephen AME Zion Church 1001 Springwood Ave, Asbury Park, NJ.

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Cell Phone Number

(###)

###

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How many school aged children in your family are you registering?

Each child must be an Asbury Park resident or attend an Asbury Park area school.

CHILD 1

Child 2 Gender

SCHOOL CHILD ATTENDS

Please provide the name of the school.

ADD ANOTHER CHILD (if applicable)

(Disregard if not applicable and go to end of this form to SUBMIT)

CHILD 2

Disregard if not applicable.

GENDER

Child 2 Gender

SCHOOL CHILD 2 ATTENDS

Please provide the name of the school.

ADD ANOTHER CHILD (if applicable)

(Disregard if not applicable and go to end of this form to SUBMIT)

CHILD 3

Disregard if not applicable.

GENDER

Child 3 Gender

SCHOOL CHILD 3 ATTENDS

Please provide the name of the school.

ADD ANOTHER CHILD (if applicable)

(Disregard if not applicable and go to end of this form to SUBMIT)

CHILD 4

Disregard if not applicable.

GENDER

Child 4 Gender

SCHOOL CHILD 4 ATTENDS

Please provide the name of the school.

ADD ANOTHER CHILD (if applicable)

(Disregard if not applicable and go to end of this form to SUBMIT)

CHILD 5

Disregard if not applicable.

GENDER

Child 4 Gender

SCHOOL CHILD 2 ATTENDS

Please provide the name of the school.

ADD ANOTHER CHILD (if applicable)

(Disregard if not applicable and go to end of this form to SUBMIT)

CHILD 6

Disregard if not applicable.

GENDER

Child 4 Gender

SCHOOL CHILD 2 ATTENDS

Please provide the name of the school.

ADD ANOTHER CHILD (if applicable)

(Disregard if not applicable and go to end of this form to SUBMIT)

CHILD 7

Disregard if not applicable.

GENDER

Child 4 Gender

SCHOOL CHILD 2 ATTENDS

Please provide the name of the school.

ADD ANOTHER CHILD (if applicable)

(Disregard if not applicable and go to end of this form to SUBMIT)

CHILD 8

Disregard if not applicable.

GENDER

Child 4 Gender

SCHOOL CHILD 2 ATTENDS

Please provide the name of the school.

ADD ANOTHER CHILD (if applicable)

(Disregard if not applicable and go to end of this form to SUBMIT)

CHILD 9

Disregard if not applicable.

GENDER

Child 4 Gender

SCHOOL CHILD 2 ATTENDS

Please provide the name of the school.

ADD ANOTHER CHILD (if applicable)

(Disregard if not applicable and go to end of this form to SUBMIT)

CHILD 10

Disregard if not applicable.

GENDER

Child 4 Gender

SCHOOL CHILD 2 ATTENDS

Please provide the name of the school.