Participation Sheet: Child ID Kit Distribution

National Child Identification Program

To: Superintendent
From: Program Coordinator, National Child ID Program

Please assign and identify below an individual on your staff ("Contact Name") to be responsible for distributing the Child ID Kits in your school district. This individual should also be the contact point for any questions from your district, or any additional communications. This form should be completed no later than Tuesday, August 14, 2007.

School District Name:

Contact Name:

Title:

Address:

City:

State:

Zip Code:

Telephone:

Fax:

Number of Kits to Be Provided: Free kits are available to every student in Kindergarten through 6th Grade at no cost to the district.

Quantity of Kits Requested:

Total K-6 enrollment:

Ship to Address: Shipments will be sent via FedEx Ground Service for orders less than 15,000. Orders over 15,000 will be sent via truck/freight service and arrive on a pallet. Each district will be responsible for distribution to every school within their district. Please provide the following district shipping information:

Attention:

Telephone:

Ship to Address (No P.O. Box)

City:

State:

Zip Code:

Please contact the Child ID Program Coordinator, 972-934-2211 or tami@childidprogram.com, if you have any questions.

Indicates Response Required