VBS Registration — Rome: Paul and the Underground Church

Step 1 of 5 — Child Information. Enter details of the child enrolling in VBS. Fields marked * are required. One form per child.

I

Child Information

Basic details about the enrolling child

First Name * First name is required.

Middle Name (optional)

Last Name * Last name is required.

Date of Birth * Date of birth is required.

Age as of June 22 * Age (3–12) is required.

Grade — Fall 2026 * Please select a grade.

Gender *

Male Female Prefer not to say

Please select gender.

Returning VBS Camper?

Step 1 of 5

Step 2 of 5 — Parent / Guardian. Primary contact, emergency contact, and authorized pickup persons.

II

Parent / Guardian Information

Contact, emergency, and pickup details

Primary Parent / Guardian

First Name *Required.

Last Name *Required.

Relationship * Required.

Cell Phone *Required.

Email Address *All VBS updates will be sent here.A valid email is required.

Home Address *Address is required.

Emergency Contact (if different from above)

Full Name *Required.

Phone *Required.

Relationship

Alternate Phone (optional)

Authorized Pickup Persons

All Adults Authorized to Pick Up Your Child * Please list authorized pickup persons.

Step 2 of 5

Step 3 of 5 — Health & Medical. This information is kept confidential and used solely to keep your child safe throughout VBS.

III

Health & Medical Information

Allergies, medications, and special needs

Child's Physician (optional)

Physician Phone (optional)

Insurance Provider (optional)

Policy / Member # (optional)

Known Allergies * Please enter allergy info (or 'None known').

Current Medications (optional) Medications stored securely and administered by trained staff.

Medical Conditions / Special Needs (optional)

EpiPen Required? *

Yes — will carry at all times No

Step 3 of 5

Step 4 of 5 — T-Shirt, Accommodations & Volunteers. Customize your child's experience and let us know if you'd like to help!

Step 4 of 5

Step 5 of 5 — Parent Agreement & Waiver. Please read each statement carefully and check the required boxes before submitting.

V

Parent Agreement & Liability Waiver

Read and acknowledge each item below

📸 Photo & Media Release: I grant Metuchen Assembly of God permission to photograph and/or video record my child during VBS 2026 activities for use in church publications and social media. Photos will not include full names without separate consent.

I consent to photo and media release for my child.

🏥 Medical Emergency Authorization: In the event of a medical emergency and if I cannot be reached, I authorize Metuchen Assembly of God staff to seek emergency medical treatment for my child. I agree to assume financial responsibility for any such treatment.

I authorize emergency medical treatment and acknowledge financial responsibility. *

📜 Program & Liability Agreement: I understand this is a Christian program with Bible-based teaching, worship, and prayer. I consent to my child's full participation. I acknowledge pickup is by authorized individuals only with photo ID. I release Metuchen Assembly of God, its staff, and volunteers from liability for injuries or illness except in cases of gross negligence.

I have read and agree to the Program & Liability Agreement. *

Electronic Signature — Full Name * Typing your name serves as your electronic signature. Signature is required.

Date * Date is required.

🔒 Your information is kept private and used solely for VBS program coordination. A confirmation email will be generated upon submission.

Step 5 of 5

Registration Complete!