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Backpack Connection Registration
Please enable JavaScript in your browser to complete this form.
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Step
1
of 5
Student's Name
Name
*
First
Last
Next
Parent Contact Information
Parent/Guardian Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Email
*
Next
Student's School Information
Student Age
*
Student Date of Birth
*
Student School Location
*
Allergies?
*
We provide a snack during each session - please let us know what to avoid!
Next
Emergency Contact Information
Contact First & Last Name
*
Relation to Student
*
Work Phone
Cell Phone
*
Next
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
REGISTER NOW
