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Backpack Connection Registration

- Step 1 of 5

Student's Name

Name *

First

Last

Gender *

Male
Female
Non-Binary/Gender Fluid
Other

Parent Contact Information

Parent/Guardian Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Student's School Information

Student Age *

Student Grade *

Student Date of Birth *

Student School Location *

Allergies? *

We provide a snack during each session - please let us know what to avoid!

Emergency Contact Information

Contact First & Last Name *

Relation to Student *

Work Phone

Cell Phone *

Permissions

All students are welcome at Backpack Connection. Bus service is provided from Coronado and Grace Stewart. Masks are required on the busses. Does your student need transportation to Trinity? *

Yes
No

My student needs transportation from: *

Grace Stewart Elementary
Coronado Elementary

Do we have permission to publish their name and photo in church digital and print media? (Social media, website, bulletin, etc) *

Yes
No

We occasionally take field trips. Do we have permission to do so? *

Yes
No

Who has permission to pick your student up from Backpack? *

Will your student walk home from Backpack? *

Yes
No

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Location & Hours

901 East Neal Ave
Salina, KS 67401

785.825.5270

tyler@triumc.org

Monday-Thursday: 8a-3p
Friday: 8a-12p