Welcome Back-2-School Form

Welcome Back-2-School!

Community Backpack Distribution
*IMPORTANT REGISTRATION ALERT*

Due to the overwhelming high volume of responses, our registration is NOW CLOSED.

You are still welcomed to register to let us know, if you are in need for other resources. We will connect you with our community partners and will do our best to full fill your request.

Thank You.
School Supplies & Readiness Backpacks

Community Backpack Distribution

The Elkridge Volunteer Fire Station

5700 Rowanberry Drive, Elkridge, MD 21075

(PARKING LOT ONLY) NO ACCESS TO INDOORS

Saturday, August 29th, 2020

10:00am -1:00pm

Registration Form
Parent Name*

Last Name
Phone*
Address*
Full Address, City and Zipcode
E-mail*
Child 1 Last Name ONLY *
Boy or Girl
Child 2 Last Name ONLY
Boy or Girl
Child 3 Last Name ONLY
Boy or Girl
Name of School Child1*
Name of School Child2
Name of School Child3
What is the Grade of Child1*
What is the Grade of Child2
What is the Grade of Child3
Do you have any additional needs of support? Please check all that apply. NOTE: If you check any of the following below, your information will be passed along to our Howard County community partners and/or Howard County Public School Coordinator at your child's school.

Need Tutoring for Child/renNeed Addition Support for Your Special Needs Child/renNeed Housing/Utilities AssistanceNeed Food AssistanceNeed Program Activities for Child/renNeed Medical AssistanceNeed Mental Health AssistanceNeed Wi-FiNeed Chrome Tablet for Virtual LearningNeed Child Care AssistanceOther
What is Your 'Other' Need?
Is there anything else you want to share?
Comments
Registration is not required, but strongly recommended to ensure that you receive a Backpack and receive the resources, that you are asking for.

REGISTRATION IS NOW CLOSED

Please contact Cindy Miller at 443-610-6500 or 410-972-8377, or cindy@justlivingadvocacy.org with any questions.

www.justlivingadvocacy.org
Should be Empty:

Welcome Back-2-School!