Hero Central VBS Registration Form
June 19th - 23rd, 9am-12pm
For children exiting PK-3 through 6th grade
Child's First Name *
Your answer
Child's Last Name *
Your answer
Parent/Guardian Name *
Your answer
Address *
Your answer
Email Address *
Your answer
Home Number
Your answer
Cell *
Your answer
Work
Your answer
Date of Birth *
Your answer
Age *
Your answer
Last school grade COMPLETED *
Home Church
Your answer
Allergies/Medical Information/Other *
Your answer
Emergency Contact 1 *
Your answer
Emergency Contact 2 *
Your answer
Dismissal Information *
Name and phone number of person(s) who may be permitted to pick up your children.
Your answer
Would you like to volunteer before/during Hero Central VBS?
Would you like to provide snacks for our volunteers?
Breakfast (donuts, muffins, etc.)
Chips
Fruit
Cookies
Bottled Water
Other
Monday
Tuesday
Wednesday
Thursday
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