Hero Central VBS CAMPER Registration Form

Monday June 8th-Friday, June 12th 5:30-7:30PM | Please fill out a separate form for each child and click submit.

Hero Central VBS is open to all children Kindergarten through 5th Grade.

Preschoolers ages 3 and up who are potty trained are welcome to join the Little Hero's with adult volunteer participation. Space is limited.

The VBC Registration fee is $10 per child with a maximum of $20 per family. Scholarships are available.

Ordering a t-shirt is optional at a cost of $10. T-shirts will be available by the end of VBC.

Child's Name

Child's Gender

Please select one option.

Male Female

Address

Cell Phone

This address will receive a confirmation email

Legal Guardians' Names

In Case of Emergency Contact (name and phone number)

Other people authorized to pick up my child.

Allergies or other medical conditions

Grade Completed

Please select one option.

PreK Kindergarten 1st 2nd 3rd 4th 5th

Birthdate (type using MM/DD/YYYY)

I give my permission for Aldersgate UMC to seek emergency medical care for my child in the event that I cannot be reached. I release Aldersgate United Methodist Church, their staff and volunteers, for any liability in the event of accident or injury.

Please select one option.

Yes No

Aldersgate UMC may use photography and video for publicity purposes. I give my permission to photograph or film my child for possible inclusion in AUMC publication, website or other publicity materials.

Please select one option.

Yes No

T-Shirt Size, if ordering the cost is $10, will be available at the end of VBC

Please select one option.

No shirt Youth X-Small (2-4) Youth Small (6-8) Youth Medium (10-12) Youth Large (14-16) Adult Small Adult Medium Adult Large Adult X-Large Adult 2XLarge

Registration Fee, max of $20 per family

Suggested Registration Fee ($10) Registration Fee plus t-shirt ($20) Requesting Scholarship ($0) Third or additional children ($0) Third or additional child with a t-shirt ($10)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Monday June 8th-Friday, June 12th 5:30-7:30PM

Please fill out a separate form for each child and click submit.

Hero Central VBS CAMPER Registration Form

Description

Please Fix the Following