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Annual Each One Reach One Back To School Program Registration Form

Step 1 of 5 – Consent to share information

Unique ID

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Applicant Consent

Why We Are Asking for Additional Information

To better align our support with the needs of the community, we now collect detailed information on household income, financial assistance, and experiences with grief and loss. This helps us ensure that our resources are reaching the families who need them the most.

Consent to Share Information (Required)

Please insert your initials as agreeing to share your information. Please note, your information will not be publicized but is only kept for data purposes to ensure our resources reach the families who need them the most.

Initials:(Required)

Consent for Media Use (Required)

I understand that participation in programs offered by the Gina Spence Program may include photography and videography. I hereby give permission for any photos or videos taken of me or my child to be used for social media, promotional, or marketing purposes by the Gina Spence Program. I acknowledge that this consent is required to complete the application. All personal information will be handled in accordance with Bermuda’s Personal Information Protection Act (PIPA).

Initials:(Required)

How many children?(Required)

Child 1

Full Name:(Required)

First Last

Gender(Required)

Male / Female

Age:(Required)

School Name:(Required)

Grade:(Required)

Shirt Color(Required)

If other, please enter shirt color below

Shirt Size(Required)

Sweater / Vest Color(Required)

If other, please enter sweater / vest color below

Sweater / Vest Size(Required)

Blazer Color(Required)

If other, please enter blazer color below

Blazer Size(Required)

Bottoms Color(Required)

If other, please enter bottoms color below

Bottoms Size(Required)

Gimp / Dress Color(Required)

If other, please enter gimp / dress color below

Gimp / Dress Size(Required)

Child 2

Full Name:(Required)

First Last

Gender(Required)

Male / Female

Age:(Required)

School Name:(Required)

Grade:(Required)

Shirt Color(Required)

If other, please enter shirt color below

Shirt Size(Required)

Sweater / Vest Color(Required)

If other, please enter sweater / vest color below

Sweater / Vest Size(Required)

Blazer Color(Required)

If other, please enter blazer color below

Blazer Size(Required)

Bottoms Color(Required)

If other, please enter bottoms color below

Bottoms Size(Required)

Gimp / Dress Color(Required)

If other, please enter gimp / dress color below

Gimp / Dress Size(Required)

Child 3

Full Name:(Required)

First Last

Gender(Required)

Male / Female

Age:(Required)

School Name:(Required)

Grade:(Required)

Shirt Color(Required)

If other, please enter shirt color below

Shirt Size(Required)

Sweater / Vest Color(Required)

If other, please enter sweater / vest color below

Sweater / Vest Size(Required)

Blazer Color(Required)

If other, please enter blazer color below

Blazer Size(Required)

Bottoms Color(Required)

If other, please enter bottoms color below

Bottoms Size(Required)

Gimp / Dress Color(Required)

If other, please enter gimp / dress color below

Gimp / Dress Size(Required)

Child 4

Full Name:(Required)

First Last

Gender(Required)

Male / Female

Age:(Required)

School Name:(Required)

Grade:(Required)

Shirt Color(Required)

If other, please enter shirt color below

Shirt Size(Required)

Sweater / Vest Color(Required)

If other, please enter sweater / vest color below

Sweater / Vest Size(Required)

Blazer Color(Required)

If other, please enter blazer color below

Blazer Size(Required)

Bottoms Color(Required)

If other, please enter bottoms color below

Bottoms Size(Required)

Gimp / Dress Color(Required)

If other, please enter gimp / dress color below

Gimp / Dress Size(Required)

Child 5

Full Name:(Required)

First Last

Gender(Required)

Male / Female

Age:(Required)

School Name:(Required)

Grade:(Required)

Shirt Color(Required)

If other, please enter shirt color below

Shirt Size(Required)

Sweater / Vest Color(Required)

If other, please enter sweater / vest color below

Sweater / Vest Size(Required)

Blazer Color(Required)

If other, please enter blazer color below

Blazer Size(Required)

Bottoms Color(Required)

If other, please enter bottoms color below

Bottoms Size(Required)

Gimp / Dress Color(Required)

If other, please enter gimp / dress color below

Gimp / Dress Size(Required)

Any questions ?

Annual Each One Reach One Back To School Program Registration Form

Applicant Consent

Applicant Information

Child 1

Child 2

Child 3

Child 4

Child 5