Serving those who serve America

Operation Hero Online Registration

Please read carefully as incomplete registration forms will not be accepted.

Site: Santa Margarita Stuart Mesa San Onofre DeLuz Mary Fay
Childs Last Name: First Name:
Middle Initial: Age:
Birth Date: Sex: Male Female
Grade Level: Teacher:
Select One: Mother Stepmother Legal Guardian
Name: DOB:
Email: Address:
City: State:
Zip: Home Phone:
Work Phone: Cell Phone:
Employer's Name: Occupation/MOS:
Employer's Address: City:
State: Zip:
Select One: Military Non-Military Rate/Rank:
Complete Company/Unit Address: Complete Company/Unit Telephone:
Select One: Father Stepfather Legal Guardian
Name: DOB:
Email: Address:
City: State:
Zip: Home Phone:
Work Phone: Cell Phone:
Employer's Name: Occupation/MOS:
Employer's Address: City:
State: Zip:
Select One: Military Non-Military Rate/Rank:
Complete Company/Unit Address: Complete Company/Unit Telephone:
Please describe the manner in which your child will be picked up or released from Operation Hero (if you opt to pick up your child you will be required to sign our late pick up policy).
Please list two emergency contacts (must be local and able to pick up your child in case of emergency):
Name: Relationship:
Phone:
Name: Relationship:
Phone:
Please indicate any areas of focus that you would like to be addressed in Operation Hero:
Is there any other information I should be aware of? Ex. Allergies, illnesses, medications, asthma, etc.

Completion of this section is optional. This information will be used for statistical purposes only.

FAMILY STATUS: Single Active Duty Dual Active Duty Active Duty With Working Spouse Active Duty With Student Spouse Active Duty With Non-Working Spouse
NUMBER OF DEPENDENTS: MILITARY STATUS: Active Duty -Enlisted
Active Duty - Officer
ETHNIC ORIGIN: Hispanic White (not Hispanic) African American Asian Pacific Islander Native American Other
OTHER ETHNIC ORIGIN:

Please read and check off to show that you accept these terms before submitting this registration form.

As the parent or legal guardian, I hereby give consent to the ASYMCA to provide all emergency dental or medical care prescribed by a duly licensed physician (MD) or dentist (DDS) for my child(ren). This care may be given under whatever conditions are necessary to preserve the life, limb, or well being of me and my dependent(s).

I understand the ASYMCA is not responsible for any costs incurred for medical or dental care.

Phone: 760-385-4921 Fax: 760-385-0785
Box 555028 Bldg 16144, Camp Pendleton, CA 92055-5028