Customized Bag Order Form Customized Bag Orders Order Date Agency * Select From Agency List Below15th NightA Family for Every ChildAcademy of Arts & AcademicsAdams Elementary SchoolAfrican American Black Student SuccessAgnes Stewart Middle SchoolAmerican Red CrossArc of Lane CountyAwbrey Park ElementaryBertha Holt Elementary SchoolBlack Thistle Street AidBohemia ElementaryBrattain HouseBriggs Middle SchoolBuena Vista Spanish Immersion SchoolCAFACAHOOTSCamas Ridge Community SchoolCASA of Lane CountyCascade Middle SchoolCatholic Community ServicesCentennial Elementary SchoolCesar Chavez Elementary SchoolCharlemagne Elementary SchoolChifin Native Youth CenterChurchill High SchoolClarvida (Formerly Maplestar)Connect the DotsConnected Lane CountyCornerstone Community HousingCorvallis School DistrictCottage Grove School DistrictCreswell School DistrictDaisy CHAINDanebo Elementary SchoolDHS - 30th StDHS - AlbanyDHS - Cottage GroveDHS - CreswellDHS - FlorenceDHS - GatewayDHS - Harlow RdDHS - McKenzie Center (Chad Dr)DHS - W 11thDHS - WillametteDirection ServiceDouglas C.A.R.E.S.Douglas ESDDouglas Gardens Elementary SchoolEarly Childhood Cares - UofOECCO High SchoolEdgewood Elementary SchoolEdison Elementary SchoolElizabeth Page Elementary SchoolEugene Islamic CenterEugene MissionEugene Online AcademyEugene 4J Welcome CenterEugene Pediatric AssociatesMcKinney Vento - EugeneMcKinney Vento - SpringfieldEugene Schools - SEALFairfield Elementary SchoolFAAPAFamily SchoolFBIFern Ridge School DistrictFox Hollow CampusFriends of the Children Lane CountyGateways High SchoolGilham Elementary SchoolGuy Lee Elementary SchoolHamlin Middle SchoolHarrisburg ElementaryHarrisburg High SchoolHarrisburg Middle SchoolHarrison Elementary SchoolHead Start - EugeneHead Start - VenetaHomes For GoodHope & Safety AllianceHoward Elementary SchoolIrving Elementary SchoolJunction City School DistrictJust Care For Families- Douglas CountyJust Care For Families- Lane CountyKalapuya High SchoolKelly Middle SchoolKinship ProgramLane Co. Behavioral HealthLane Co. Developmental DisabilitiesLane Co. Child & Adolescent ProgramLane Co. Family & Child HealthLane Co. H&HS Dovetail ProgramLane Co. Maternal HealthLane Co. Parole & ProbationLane Co. WICLane Co. Youth ServicesLane ESD - Behavioral HealthLane ESD - MEPLane School - EugeneLane Workforce PartnershipLinn-Benton Lincoln ESDLooking GlassLOVE for Lane Co.Lowell School DistrictMainstream Housing Inc.Malabon Elementary SchoolMaple Elementary SchoolMapleton School DistrictMarcola School DistrictMcCornack Elementary SchoolMonroe Middle SchoolMt. Vernon Elementary SchoolNetwork Charter SchoolNorth Eugene High SchoolNurse Family PartnershipOaklea Middle SchoolOakridge School DistrictOffice of Disabled ServicesOregon Family Support NetworkPacificSource Health PlansParenting NowPearl Buck CenterPlaza (Formerly Centro Latino)Pleasant Hill School DistrictPreschool PromiseRelief NurseryRidgeview Elementary SchoolRISP (Refugee & Immigrant Services Program)Riverbend Elementary SchoolRiverview Center for GrowthSafe Families for Children of Lane Co.Shasta Middle SchoolShelterCareSheldon High SchoolSiuslaw Middle SchoolSouth Eugene High SchoolSouth Lane Mental HealthSouth Lane School DistrictSpencer Butte Middle SchoolSpringfield Family Resource CenterSpringfield High SchoolSpringfield Police Dept.Springfield Schools Newcomer ProgramSpring Creek Elementary SchoolSponsors Inc.Support Services For Veteran FamiliesSVDP - Chad Dr.SVDP - First PlaceThurston ElementaryThurston Middle SchoolThurston High SchoolTrillium Community Health PlanTwin Oaks Elementary SchoolTwo Rivers - Dos Rios Elementary SchoolVital Villages ORWalterville Elementary SchoolWellMamaWestern Lane Crisis ResponseWillagillespie Elementary SchoolWillamette Family Inc.Willamette Family Women's Residential ProgramWillamette High SchoolYolanda Elementary SchoolYujin Gakuen Japanese Immersion ElementaryNew Option Agency Contact * Agency Address * Agency Address Agency Address Agency Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Contact Phone * OK to Text? Yes No Contact Email * Bag Order Pickup Date Order will be picked up Special Instructions Individual Orders Complete a new entry for each child. Demographics for Grant Reporting * Housed Unhoused * Urban Rural * White Non-White Age 0-3 Months6 Months9 Months12 Months18 Months234567891011121314151617 Please Select Gender * GirlBoyNon-Binary (11+) If gender is nonbinary, please indicate type of underwear: Girl Boy Name or Identifier Shirt Size * PreemieNewborn0-3 Months6 Months9 Months12 Months18 MonthsChild 2TChild 3TChild 4TYouth 5/6 - XSYouth 7/8 - SYouth 10 - MYouth 12 - MYouth 14 - LYouth 16 - XLAdult SAdult MAdult LAdult XLAdult 2XLAdult 3XLAdult 4XLAdult 5XL Pant Size - Please include waist and inseam for Boys in inches * Shoe Size *Please note that we might not have every size in stock Please include: * Diapers - Please indicate size in Preferences/Likes/Dislikes Pull-ups - Please indicate size in Preferences/Likes/Dislikes Underwear Include school supplies? * Yes No Preferences/Likes/Dislikes plus1 Add Another Bag minus1 Remove Previous Bag Submit If you are human, leave this field blank.
