Community Coalition for Family Wellness
Home
In Partnership with The Alcohol and Substance Abuse Prevention Council of Saratoga County
and the South Glens Falls School District
In order to receive a free medication lock box from the community coalition for family wellness, for self-installation in your residence, please fill out the following registration and demographic forms.
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
I am in South Glens Falls School District
*
Yes
No
What school does your child or grandchild attend (Check all that Apply)
*
Moreau Elementary
Harrison Ave. Elementary
Tanglewood Elementary
Ballard Rd. Elementary
Oliver Winch Middle
South Glens Falls High
Graduated From South High
Not Applicable
Submit
Optional Questions
*
Indicates required field
When you last disposed of medications, where did you do so
*
Prefer not to say
Deterra bag
Drop box
Take-Back event
Flush them
I have not disposed of medications
Do you know what a Deterra bag is?
*
Yes
No
Submit
Home