Electronic Equipment Reclamation Project - Child in Need Form

  • strict warning: Non-static method view::load() should not be called statically in /home/itbajo7ed0oo/public_html/sites/all/modules/views/views.module on line 906.
  • strict warning: Declaration of calendar_plugin_display_page::options_submit() should be compatible with views_plugin_display_page::options_submit(&$form, &$form_state) in /home/itbajo7ed0oo/public_html/modules/acquia/calendar/includes/calendar_plugin_display_page.inc on line 0.
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  • strict warning: Declaration of calendar_plugin_display_ical::options_submit() should be compatible with views_plugin_display_page::options_submit(&$form, &$form_state) in /home/itbajo7ed0oo/public_html/modules/acquia/calendar/calendar_ical/calendar_plugin_display_ical.inc on line 0.
  • strict warning: Declaration of views_handler_filter::options_validate() should be compatible with views_handler::options_validate($form, &$form_state) in /home/itbajo7ed0oo/public_html/sites/all/modules/views/handlers/views_handler_filter.inc on line 0.
  • strict warning: Declaration of views_handler_filter::options_submit() should be compatible with views_handler::options_submit($form, &$form_state) in /home/itbajo7ed0oo/public_html/sites/all/modules/views/handlers/views_handler_filter.inc on line 0.
  • strict warning: Declaration of views_handler_filter_boolean_operator::value_validate() should be compatible with views_handler_filter::value_validate($form, &$form_state) in /home/itbajo7ed0oo/public_html/sites/all/modules/views/handlers/views_handler_filter_boolean_operator.inc on line 0.
  • strict warning: Declaration of date_api_filter_handler::value_validate() should be compatible with views_handler_filter::value_validate($form, &$form_state) in /home/itbajo7ed0oo/public_html/sites/all/modules/date/includes/date_api_filter_handler.inc on line 0.
  • strict warning: Only variables should be passed by reference in /home/itbajo7ed0oo/public_html/sites/all/modules/date/date_api.module on line 866.
  • strict warning: Only variables should be passed by reference in /home/itbajo7ed0oo/public_html/sites/all/modules/date/date_api.module on line 866.
  • strict warning: Only variables should be passed by reference in /home/itbajo7ed0oo/public_html/sites/all/modules/date/date_api.module on line 866.
  • strict warning: Only variables should be passed by reference in /home/itbajo7ed0oo/public_html/sites/all/modules/date/date_api.module on line 866.
  • strict warning: Only variables should be passed by reference in /home/itbajo7ed0oo/public_html/sites/all/modules/date/date_api.module on line 866.
  • strict warning: Only variables should be passed by reference in /home/itbajo7ed0oo/public_html/sites/all/modules/date/date_api.module on line 866.
  • strict warning: Only variables should be passed by reference in /home/itbajo7ed0oo/public_html/sites/all/modules/date/date_api.module on line 866.
  • strict warning: Only variables should be passed by reference in /home/itbajo7ed0oo/public_html/sites/all/modules/date/date_api.module on line 866.
  • strict warning: Only variables should be passed by reference in /home/itbajo7ed0oo/public_html/sites/all/modules/date/date_api.module on line 866.
  • strict warning: Declaration of views_plugin_row::options_validate() should be compatible with views_plugin::options_validate(&$form, &$form_state) in /home/itbajo7ed0oo/public_html/sites/all/modules/views/plugins/views_plugin_row.inc on line 0.
  • strict warning: Declaration of views_plugin_row::options_submit() should be compatible with views_plugin::options_submit(&$form, &$form_state) in /home/itbajo7ed0oo/public_html/sites/all/modules/views/plugins/views_plugin_row.inc on line 0.
  • strict warning: Non-static method view::load() should not be called statically in /home/itbajo7ed0oo/public_html/sites/all/modules/views/views.module on line 906.

Electronic Equipment Reclamation Project – Child in Need Form
 
Grade of child requiring assistance: (Please check one)
 
Elementary School________              Middle or Junior High School________               High School________
 
Child’s Name_________________________________________________________________________________
 
Child’s Parent/Guardian Name__________________________________________________________________
 
Name of school child attends___________________________________________________________________
 
School Address_______________________________________________________________________________
 
General Information Telephone_________________________________________________________________
 
Name of Principal_____________________________________________________________________________
 
Principal Telephone_____________________________________________________________Ext___________
 
Type of Equipment Needed____________________________________________________________________
 
____________________________________________________________________________________________
 
____________________________________________________________________________________________
 
Reason for Assistance________________________________________________________________________
 
____________________________________________________________________________________________
 
Squeeky Clean Member Information
 
Member Name________________________________________________________________________________
 
Member User ID______________________________________________________________________________
 
Member Email________________________________________________________________________________
 
Member Telephone___________________________________________________________________________
 
Return to:  www.squeekyclean.org, Squeeky Clean, LLC, P.O. Box 32, Hesperus, CO  81326