Free Medication Lock Boxes

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.

 

FREE Medication Lock Box Registration Form

*Required
*Name:
*Address:

*City:
*State:

*Zip:
*Email:

*I am in South Glens Falls School District:


* What school does your child or grandchild attend (Check all that Apply):









When you last disposed of medications, where did you do so:






Do you know what a Deterra bag is?: