Family Registration - 2026 FRS Shop With A HERO

Family Registration for FRS Shop with a HERO
Shop with a HERO – Family Eligibility & Event Guidelines
Eligibility Overview
1. Families must reside in Boone County, Missouri.
2. Families who have been selected in this event in previous years are not eligible to apply.
3. Families who are currently receiving similar opportunities are not eligible to apply.
4. The household must include at least one (1) child under the age of 16 who resides primarily with the parent or guardian listed on the application. (Those over 16 years of age are not eligible for this program)
5. Items purchased during the event must directly benefit the child(ren) living in the household.
6. Submission of an application does not guarantee selection.
7. Families will be chosen based on the information provided in their application.
8. If selected, families must be able to attend their scheduled event time.
2026 Event Dates & Locations
1. Thursday, December 3 – West Broadway Walmart
2. Tuesday, December 8 – Conley Walmart
3. Thursday, December 10 – Grindstone Walmart
If you have questions about this application or the Shop with a HERO program, please contact Adam Burks at aburks@mofrs.org or by phone at (573) 354-8013
Confirmation of Program Eligibility

By acknowledging below, you confirm that you have read and understand the Family Eligibility & Event Guidelines above and certify that your family meets the eligibility requirements to apply.

Family Application or Referral

Please let us know if you are completing this application for your own family or on behalf of another family as a referral. If submitting a referral, you will be asked to provide your contact information and your relationship to the family.
Are you completing this form on behalf of a Boone County, MO family?

Referral Contact Information

Please provide your contact information below as the person referring this family to the Shop with a HERO Program. This information will allow First Responder Support to contact you if we have questions or need additional information regarding the referral.
Referral Contact Name

First NameLast Name
Referral Contact Job Title / Position
Counselor, Teacher, Social Worker, Administrator, Friend, etc.
Referral Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Referral Contact Email
example@example.com
Additional information provided by family referral
Please tell us if there is any additional information that the FRS Shop With A HERO team should know about your referral.

Family Information

Please complete the following sections for the family contact(s). These contact(s) will serve as the main point of contact for First Responder Support (FRS) and will receive notifications and important communications regarding the Shop with a HERO application and event. Please ensure all contact information is complete and accurate so FRS can successfully communicate with your family.
Primary Family Contact Information
Parent/Guardian Full Name - Primary Contact

First NameLast Name
Home Address - Primary Contact

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address - Primary Contact
example@example.com
Cell Phone Number - Primary
Please enter a valid phone number that we can reach the family.Format: (000) 000-0000.
Event Communication & Text Message Consent

First Responder Support (FRS) will communicate with participating families by email and text message. Important event information, including scheduling details, reminders, changes, and other time-sensitive updates, will be sent by text message. Because of the large number of families participating in Shop with a HERO, it is very important that you provide a valid mobile number and regularly review messages from FRS.

By providing your mobile number, you consent to receive text messages from First Responder Support (FRS) related to the Shop with a HERO program and event. Message and data rates may apply. You may opt out of text messages at any time; however, doing so may result in missing important or time-sensitive event information, including scheduling updates, reminders, or changes.
Secondary Family Contact Information
Parent/Guardian Full Name - Secondary Contact

First NameLast Name
Email Address - Secondary Contact
example@example.com
Cell Phone Number - Secondary Contact
Please enter a valid phone number that we can reach the family.Format: (000) 000-0000.
Event Communication & Text Message Consent

First Responder Support (FRS) will communicate with participating families by email and text message. Important event information, including scheduling details, reminders, changes, and other time-sensitive updates, will be sent by text message. Because of the large number of families participating in Shop with a HERO, it is very important that you provide a valid mobile number and regularly review messages from FRS.

By providing your mobile number, you consent to receive text messages from First Responder Support (FRS) related to the Shop with a HERO program and event. Message and data rates may apply. You may opt out of text messages at any time; however, doing so may result in missing important or time-sensitive event information, including scheduling updates, reminders, or changes.

Child Information

Please provide the following information for each child in the household, including all children who may be eligible to participate in the Shop with a HERO event.
How many children under the age of 16 are living in the household?
Please list all children under the age of 16 living in the household
Tell Us About Your Family

Please briefly tell us why your family would benefit from participating in the 2026 Shop with a HERO Program. Please limit your response to 200 words or less.0/200
Do you have any special requests or notes that you would like to share with event organizers?

Rows	First Priority	Second Priority	Third Priority	Not Available
Thursday, December 3 – Grindstone Walmart
Tuesday, December 8 – Conley Parkway Walmart
Thursday, December 10 – West Broadway Walmart

Family Registration for FRS Shop with a HERO

Shop with a HERO – Family Eligibility & Event Guidelines

Eligibility Overview

2026 Event Dates & Locations

Confirmation of Program Eligibility

Family Application or Referral

Referral Contact Information

Family Information

Primary Family Contact Information

Secondary Family Contact Information

Child Information

Shop With A HERO Event Details