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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