Clone of 2025 Backpack Giveaway

Registration Form 2026

In Collaboration with the Lancaster School District
This year, for the 5th annual back-to-school backpack giveaway, the City of Lancaster in collaboration with the Lancaster School District are giving away 10,000 backpacks filled with school supplies for students in Tk through 12th grade at three different hub locations; limit 1 backpack per present child.
- Deputy Pierre W. Bain Park - 45045 5th St E, Lancaster, CA 93535
  - Fun Water Play
  - Family Games
  - World of Soccer Exhibition
  - Health Services
  - Student Immunizations
  - Vision Services
  - Oral Hygiene Services
- Park View Educational Complex - 44327 Fig Ave, Lancaster, CA 93534
  - Family Games
  - Health Services
  - Student Immunizations
  - Vision Services
  - Oral Hygiene Services
- (Drive- Up Only) Joe Walker Middle School - 5632 W Ave L 8, Quartz Hill, CA 93536
(**CHILDREN MUST BE PRESENT)
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Household Size
Adults and Children Living in Home
Please Indicate the Number of Children Receiving Services
Backpacks, Immunizations, Health Services, Etc.
1. Student Name

First NameLast Name
DOB

MonthDayYear
Date
Grade Level
2. Student Name

First NameLast Name
DOB

MonthDayYear
Date
Grade Level
3. Student Name

First NameLast Name
DOB

MonthDayYear
Date
Grade Level
4. Student Name

First NameLast Name
DOB

MonthDayYear
Date
Grade Level
5. Student Name

First NameLast Name
DOB

MonthDayYear
Date
6. Student Name

First NameLast Name
DOB

MonthDayYear
Date
Grade Level
Grade Level
Is your family interested in receiving free immunizations?
School Aged Immunizations (grades K-12 only)

Immunizations are available for K-12 students only and will be provided on a first come, first served basis, while supplies last. All services are offered in collaboration with our trusted partners.
How many DTaP/Tdap Immunizations?
How many DTaP/Tdap Immunizations?
How many DTaP/Tdap Immunizations?
How many DTaP/Tdap Immunizations?
How many DTaP/Tdap Immunizations?
How many DTaP/Tdap Immunizations?
How many MMR Immunizations?
How many MMR Immunizations?
How many MMR Immunizations?
How many MMR Immunizations?
How many MMR Immunizations?
How many MMR Immunizations?
How many Varicella Immunizations?
How many Varicella Immunizations?
How many Varicella Immunizations?
How many Varicella Immunizations?
How many Varicella Immunizations?
How many Varicella Immunizations?
How many HepB Immunizations?
How many HepB Immunizations?
How many HepB Immunizations?
How many HepB Immunizations?
How many HepB Immunizations?
How many HepB Immunizations?
How many Polio Immunizations?
How many Polio Immunizations?
How many Polio Immunizations?
How many Polio Immunizations?
How many Polio Immunizations?
How many Polio Immunizations?
How many Meningitis Immunizations?
How many Meningitis Immunizations?
How many Meningitis Immunizations?
How many Meningitis Immunizations?
How many Meningitis Immunizations?
How many Meningitis Immunizations?
Health Services

Services will be provided on a first come, first served basis, while supplies last. All services are offered in collaboration with our trusted partners. Healthcare screenings, eye exams, and dental hygiene services are available for K-12 students only.
Is your family interested in Free Health Services?
Please select all services your family is interested in.
Service Hub Locations

Free Backpacks with School Supplies, Immunizations, and Health Services will be available at all hub locations listed below. Each hub will also offer free parking, access to local resource information, and family-friendly activities for all ages.
Please select your preferred service hub location
Please select your preferred service hub location
Should be Empty:

Registration Form 2026

School Aged Immunizations (grades K-12 only)

Health Services

Service Hub Locations