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Backpack Registration - Stevens Hill Community
3131 Turnpike Road
Elizabethtown, PA 17022
717-367-7299
Questions? brirot5@gmail.com
Email address *
Name of Parent(s) accompanying child: *
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First & Last Name of Child & Age: *
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First & Last Name of Child & Age:
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First & Last Name of Child & Age:
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First & Last Name of Child & Age:
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Address: *
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Cell Phone: *
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List Names of other persons authorized to accompany your child/children in your absence: *
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I give permission for my child to be photographed. I understand that the images may be displayed in the church publications, church buildings or website. I understand that as a precaution my child's name will not be published or linked with photographs. *
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