The Ann B. Clark Co-op
Which of the following best describes you?
Current Goodwin Faculty/Staff/Admin
Current Goodwin Student
Parent of a current CTRA Student
Parent of a current RMS Student
First Name
Last Name
Email
Phone
Household Size
Select Household Size
0
1
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4
5
6
7
8
9
10
How many in your household are under 13?
Select household members under 13
0
1
2
3
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5
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8
Are you in need of children’s diapers?
Yes
No
If yes, what size?
Does anyone in your household have food allergies?
Yes
No
Describe allergies
If you are human leave this field blank
