Form - Request for Student Footwear from The Old Newsboys Association

Request for Student Footwear from The Old Newsboys Association

Parent/Guardian: Complete the form below “PLEASE PRINT” and return it to:

Lansing School District
519 W. Kalamazoo St.
Lansing, MI, 48933

School Old Newsboys Coordinator: Rose Taphouse, 517.755.2813

Parent/Guardian First and Last Name

Address including Apt. #, City and Zip Code

Phone Number

Number in the Family

Number of Children

Number of Children in School

Tell us About Your Child/Children

First Child's Full Name

First Child's Date of Birth

First Child's School

Second Child's Full Name

Second Child's Date of Birh

Second Child's School

Third Child's Full Name

Third Child's Date of Birth

Third Child's School

Fourth Child's Full Name

Fourth Child's Date of Birth

Fourth Child's School

Fifth Child's Full Name

Fifth Child's Date of Birth

Fifth Child's School

Sixth Child's Full Name

Sixth Child's Date of Birth

Sixth Child's School

By checking this box, you give permission for the school to provide whatever information the Old Newsboy requires to complete this application. (required)

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