Hero Central VBS Registration
Where: 4640 West Market St Leavittsburg
When: June 19th - 23rd
9:00 am – 12:30*

*Please note VBS ends at 12:30. A free lunch is provided from 12:00 – 12:30

Child's First Name
Your answer
Child's Last Name
Your answer
Child's Address
Your answer
Child's City
Your answer
Child's Zip
Your answer
Home Phone Number
Your answer
Child's Age
Child's Grade Level
Child's Birthdate (MM/DD/YYYY)
Your answer
Food Allergies or Medical Conditions
Your answer
Mother's Name (Guardian 1)
Your answer
Contact # for Mother (Guardian 1)
Your answer
Father's Name (Guardian 2)
Your answer
Contact # for Father (Guardian 2)
Your answer
Do you attend First Community Church
Do you attend our AWANA program
Did someone invite you? If so, please tell us who!
Your answer
Email Address
Your answer
Confirm Email Address
Your answer
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