Rutgers VBS 2019 Registration
Join us this year for Vacation Bible School as we explore themes of peacemaking and community building.  Our VBS is for children ages 4-11 and runs from 9 AM-12 PM.  We look forward to working with your child!
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Last Name *
First Name *
Each child must be registered separately.
Parents/Guardians *
All listed parents/guardians are also authorized for pick up.
Date of Birth *
Groups will be arranged based on date of birth.  All children must be 4 years old by August 5th, 2019.
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Address *
City, State, Zip *
Email Address *
Primary Phone *
Secondary Phone
Special Needs/Allergies *
Authorized Pick up Name and Phone Number 1 *
Other than parent(s)/guardian(s).
Authorized Pick up Name and Phone Number 2
Other than parent(s)/guardian(s).
Emergency Contact Name and Number 1 *
Emergency Contact Name and Number 2
Week(s) *
Sign up for one or both weeks!  The registration fee is $55 per week per child.
Required
Payment: By clicking below, I verify that I will submit payment, either in cash or with a check to "Rutgers Presbyterian Church".  I recognize that my child(ren)'s spot will not be officially confirmed until payment is received.  Once payment is received, a confirmation email will be sent. *
The registration fee is $55 per week per child.
Child Authorization: By clicking below, submitting this registration form, and enrolling in the classes listed above, I verify that my child has no condition that limits or prohibits participation in these programs.  I also authorize the use of my or my child's image for promotional purposes. *
Waiver, Release, and Consent: By clicking the box below, I hereby release and discharge Rutgers Presbyterian Church and its constituent organizations and their officers, agents and employees from any and all claims for personal injuries or property damage that may be suffered as a result of participation in the activity described above. I hereby warrant and represent that my child is physically fit and capable of taking part in such activity. I make this warranty and representation on the basis of advice given by a duly licensed medical doctor within the last six months, and I know of no change since receiving that advice that would affect the opinion of said medical doctor. I / my child agree(s) to abide by the rules and regulations governing the above-described activity and to obey an instructions given by the person or persons having supervision and control over the activity. I hereby authorize that if my child requires emergency medical care and I cannot be reached, I give my consent to Rutgers Presbyterian Church to obtain the necessary medical care for my child. I agree to pay all of the costs associated with the emergency medical care that my child receives. I understand that every effort will be made to contact me before and after emergency medical care is provided. *
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