1. JCA Uniform Exchange Donations
Complete the entire form, and place in bag with donated items
Donor Information
Donor Name (Printed as it should appear on receipt or voucher): __________________________
Address ______________________________________________________________________
Phone ______________________________
E-mail ________________________________________________
Item Information
Please list all items you are donating to the School Uniform Exchange, and please be specific. For
example…3 blue polo shirts size 8, 2 pair of girls’ khaki pants size 8.
Item Name and Description: _____________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Donor Signature ____________________________________ Date ______________________
Check appropriate selections:
_____ I do not wish to receive a credit voucher for the items I have donated. I understand
that my donation is tax deductible according to IRS standards.
_____ I wish to receive a credit voucher for the items I have donated.
_____ My items are new or laundered (gently used), have all buttons/zippers/etc., conform to the
standard school attire policy of Jericho Christian Academy and have no stains or tears.
_____ I understand that my voucher will be available at the registration table during the
scheduled Uniform Exchange Hours
_____ I understand that JCA will not pay cash for any donated items or unused vouchers.
_____ I understand JCA will have no control over and cannot guarantee the availability or
quantity of items, sizes, colors, etc. at the exchange. All exchanges will be on a first-come, first-
served basis.
*If you wish to receive a credit voucher, you must check that you understand and agree to
the terms above.
Staff member/volunteer who received/inventoried ________________________ Date ________
Staff/Volunteer Notes:
Cut along this line and retain for you records_____________________________________________________________
JCA Uniform Exchange Donor Information
Donor Name (Printed as it should appear on receipt or voucher): __________________________
Address ______________________________________________________________________
Phone ______________________________
E-mail ________________________________________________
Item Information
Please list all items you are donating to the School Uniform Exchange, and please be specific. For
example…3 navy blue
polo shirts, 2 pair of girls’ khaki pants size 8.
Item Name and Description: _____________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Donor Signature ____________________________________ Date ______________________