Student Registration — Pack the Mack

1Parent & Students

2Services & Times

3Releases & Sign

Students must be present to receive a backpack.

Parent / Guardian Information

All fields are required.

Parent/Guardian First Name* Parent/Guardian Last Name*

Parent/Guardian Email* Parent/Guardian Phone*

Zip Code*

Students

How many students are you registering? (max 6)*

🎒 Backpack & School Supplies

All Students

Students must be present to receive a backpack.

Choose one pickup time for your family. Every student receives a backpack with supplies.

✂️ Free Haircut

Optional

We will make every effort to provide haircuts for all registered children; however, haircut services are subject to availability and cannot be guaranteed. We appreciate your understanding.

Would you like to sign up for a free haircut?

Select which student(s) would like a haircut:

🏥 Free Dental Screening

Optional

We will make every effort to provide dental screening for all registered students; however, dental screening is subject to availability and cannot be guaranteed. We appreciate your understanding.

Would you like to sign up for a free dental screening?

Select which student(s) would like a dental screening:

Required Releases

Please read both forms, then acknowledge and sign below. One signature covers all registered students.

📄 Read: Assumption of Risk & Release of Liability

I have read and agree to the Assumption of Risk & Release of Liability.

📄 Read: Photo / Video Release Form

I have read and agree to the Photo / Video Release Form.

Signature

By signing, you confirm you are 18+ and have read both forms above.

Full Legal Name*

Date of Birth*

Today's Date*

Please confirm you're human before submitting:

✅

Registration Complete!

Thank you for registering your child(ren) to attend the Pack the Mack Back-to-School Event on July 30th. Your registration is now complete, and we look forward to seeing you on the day of the event. If you have any questions, please reach out to ooce@lvmpd.com

Confirmation Code—

Please read the release form

Your registration did not go through

Parent / Guardian Information

Students

🎒 Backpack & School Supplies

✂️ Free Haircut

🏥 Free Dental Screening

Required Releases

Signature

Registration Complete!