Event Registration

Please complete the registration information below to help us ensure we have enough backpacks and supplies for the students in need that will attend the event! Registration is not required and we will allow walk-up attendees the day of the event. If you have any questions, please don't hesitate to reach out to the Heyl Family Practice Office at 412-931-3066 and ask for Jessica!

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* 1. Parent/Guardian Name

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* 2. Phone (optional)

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* 3. Please choose a preferred time-slot for your backpack pick-up:

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* 4. How many people (adults and children in total) will attend the event?

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* 5. Please list each child and their grade level that will attend the event and receive a backpack.

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