Caregiver Resources

Request Placement Box

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Personal Information

First Name

Last Name

Contact number

Email Address

Address

City

State/Region/Province

Postal / Zip Code

Country

Placement Information

Please select which is applicable to you.

Name of Licensing Agency and/or Assigned CPS Caseworker

Date of placement

Have you ever received a placement box from us?

Yes No

How many children are in this placement?

Please provide EACH child's gender and age.

County of case

Terms and Contions

I understand some items are gently used donations. AST makes no claims, representations, or warranties as to the safety, reliability, durability, and performance of any of these items. AST cannot accept liability for the items distributed.

Consent

I agree and contest that all information provided is accurate and true.

ABOUT US

The BOSS Mentoring Program provides support and guidance to young people at Shoemaker High School who are experiencing difficulties in learning due to social, emotional or behavioural problems or other issues.

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