2025 Mission in Motion Registration Form

Please fill out this form and click submit.

Participant Information

Name (First and Last)

Preferred Name

Date of Birth

Age

Address

Grade Completed in 2024-2025 School Year

Please select one option.

Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th

School

Parent/Guardian Infotmation

Parent/Guardian Name (First and Last)

This address will receive a confirmation email

Phone (where you can be reached during Mission in Motion)

Safety Information

Please list any of the participant's food allergies or intolerances:

Please list any of the participants other allergies:

Does the participant have any other medical conditions that Leaders should be aware of?

Does the participant carry any of the following medical devices at all times?

Please select one option.

EpiPen Inhaler Blood Sugar Monitor Mobility Aid (specify below) Other

If you selected

Emergency Contacts

Emergency Contact 1: Name

Emergency Contact 1: Phone Number

Emergency Contact 1: Relationship to Participant

Emergency Contact 2: Name

Emergency Contact 2: Phone Number

Emergency Contact 2: Relationship to Participant

Sign-Ins and Sign-Outs: For the protection of both parents and children, Asbury requires children through grade 5 to be signed in and out of church-sponsored activities. I authorize the following adults to sign in or sign out my child :

Asbury activities may include video or photography projects. My child may participate as a subject of Asbury video or photography projects.

Please select one option.

Yes No

Description

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2025 Mission in Motion Registration Form

Description

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