Asbury VBS Child Registration

Please enter separate registrations for each child. Simply fill out the form and we will send you one as soon as we can.
  • What grade will your child be this coming Fall 2018?
  • T-shirts are included this year with registration
    Please let us know what campus you regularly attend

    Please fill out completely for each child.
  • I consent to the use of my child's image or voice in photographs, audio and/or video recordings taken during the course of the event for the purpose of promoting and marketing.
  • I authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to the authorization.
  • Please list all medical, food and other allergies for your child. If none, please write "NONE."
  • Please list anyone who CANNOT pick-up your child.