Outfitters | Referrals

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Parent/Guardian Name *

How many children are you shopping for? *

Relationship to Child(ren) *

Marital Status

Married

Single

Widowed

Divorced

Separated

Address *

City *

State *

Zip *

Phone *

Email *

Today's Date

How did you hear about Outfitters?

Demographic Information

Outfitters, Inc. applies for grants and/or state and federal funding to help supplement the daily operations of the organization. The following information will help us to complete these applications and will only be sued for those purposes.

Race

Caucasion

African American

Bi-Racial

Asian

Hispanic

AM Indian

Other

Religious Affiliation

Occupation

Place of Employment

Yearly Household Income

$0-$15,000

$15,000-$25,000

$25,000-$35,000

$35,000-$45000

$45,000-$55,000

If Above $55,000 Please List AMT.

How many live in your household under the age of 18?

How many live in your household over the age of 18?

CONFIDENTIALITY POLICY AGREEMENT

Outfitters keeps client records personal and confidential and available only to a small number of personnel necessary to efficiently run our organization. The school, church or social service agency that referred your child may be contacted to verify eligibility and/or receive notification that your child received our services. All Outfitter volunteers are also required to sign a Confidentiality Policy Agreement prior to working with our families. Should another social service agency or program inquire whether your family received services from Outfitters, we may release that information only to prevent duplication of services.

Outfitters may at times receive requests from church groups, individuals, etc. for the names of families who are in need of assistance during the holidays. Please check the appropriate box below to let Outfitters know if we have permission to release your information.

Info Release

Yes, Outfitters may release my information to organizations, individuals, etc. who are seeking to assist families in need of assistance. I understand this does not guarantee additional assistance.

No, I do not give Outfitters permission to release my information to organizations, individuals, etc. who are seeing to assist families in need of assistance.

Confidentiality Acknowledgement

I have read and understand the above Confidentiality Policy Agreement.

Child 1

What is your child's first name? *

What is your child's last name? *

Date of Birth *

What is your child's gender?

Male

Female

What grade is your child in? *

What school does your child attend? *

What size is your child wearing these days? *

Now we need a few specific sizes for your child to make sure they receive some great fitting items!

What is your child's sock size? *

Any Special Instructions?

What is your child's underwear size? *

Any Special Instructions?

(runs small or large, needs expandable waistband, etc.) (required)

Child 2

What is your first child's name? *

What is your last child's name? *

Date of Birth *

What is your child's gender?

Male

What is your child's sock size? *

Any special instructions?

What is your child's underwear size? *

Any special instructions?

Shopping and Clothing Pick Up Information

Due to COVID-19 protocol, our shopping experience will look a little different this year. Please read the following information thoroughly before filling out the mandatory client form:

Shopping List:

Demographic Information

CONFIDENTIALITY POLICY AGREEMENT

Child 1

Now we need a few specific sizes for your child to make sure they receive some great fitting items!

Child 2

Now we need a few specific sizes for your child to make sure they receive some great fitting items!

Child 3

Now we need a few specific sizes for your child to make sure they receive some great fitting items!

Child 4

Now we need a few specific sizes for your child to make sure they receive some great fitting items!

Child 5

Now it's time to get into clothing options. We'll need your child's specific sizes to make sure we pick some great fitting items!

Outfitters Clothes

Useful Information

Indiana

Hours