Asbury's VBS Registration Card
Child's First Name:  *
Child's Last Name:  *
Address:  *
City:  *
State:  *
Zip Code:  *
Home Phone:  *
Cell Phone:  *
(None if not applicable)
Birth Date:  *
Gender:
	Female Male
Grade in Fall:  *
School Attending (if any):  *
(None if not applicable)
Parent or Guardian:  *
Email Address:  *
Work Phone:  *
Home Church (if any):  *
(None if not applicable)
Allergies:  *
(None if not applicable)
Medications:  *
(None if not applicable)
Special Needs:  *
(None if not applicable)
Emergency Contact Name:  *
Emergency Contact Phone:  *
To Pre-order T-shirts @ $11.00 each:
Childrens Shirts Wanted  *
	None Child small (6-8) Medium (10-12) Large (14-16)
Adult Shirts Wanted  *
	None Small Medium Large X-large
To Pay for the T-shirts you can send your check to the church Attn: Beth Gray-VBS or pay for them on arrival.
By registering I give permission to use photos of my child to support Asbury Children's Ministries
How did you find out about VBS at Asbury?
	Church Member Church Visitor Church Sign "Mom's Directory" Friend School Summer Fair Other
Comments:  *
(none if not applicable)
Security code:   *

* indicates a required field