Asbury United Methodist Church

Student Name*

First Name Last Name

Student DOB:*

Month Day Year

Name of School:*

Grade:*

Parent Name:*

First Name Last Name

Parent Phone Number*

- Area Code Phone Number

Mailing Address:*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent E-mail:

Emergency Contact Names and Numbers:*

School Sharpener students will participate in a number of activities and pictures will often be taken. These pictures could be used in newsletters, media, on our website, and in our project portfolio. Please check the appropriate box below.

Check one:*

My child may be photographed. My child may not be photographed.

Check one:*

My child may utilize the internet while at School Sharpener. My child may not may not uterlize the internet while at School Sharpener.

Registration Payment:*

First Semester $50.00 USD
Second Semester $50.00 USD

Total: $0.00 USD

UPCOMING EVENTS

DAILY DEVOTIONS

SCHOOL SHARPENER REGISTRATION FORM

2010-2011