VBS Camper Registration

Select number of your children attending 2026 VBS Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Child Grade Entering Sept. 2026 REQUIRED Please fill out this field.
- Child Gender REQUIRED Please fill out this field.
- Does your child have allergies? REQUIRED Yes No Please fill out this field.
- If yes, please provide details. Please enter valid data.
- Does your child require medication? REQUIRED Yes No Please fill out this field.
- If yes, please provide details. (i.e., Epi pen, etc.) A separate medical consent form will be emailed for parent signature. Please enter valid data.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Child Grade Entering Sept. 2026 REQUIRED Please fill out this field.
- Child Gender REQUIRED Please fill out this field.
- Does your child have allergies? REQUIRED Yes No Please fill out this field.
- If yes, please provide details. Please enter valid data.
- Does your child require medication? REQUIRED Yes No Please fill out this field.
- If yes, please provide details. (i.e., Epi pen, etc.) A separate medical consent form will be emailed for parent signature. Please enter valid data.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Child Grade Entering Sept. 2026 REQUIRED Please fill out this field.
- Child Gender REQUIRED Please fill out this field.
- Does your child have allergies? REQUIRED Yes No Please fill out this field.
- If yes, please provide details. Please enter valid data.
- Does your child require medication? REQUIRED Yes No Please fill out this field.
- If yes, please provide details. (i.e., Epi pen, etc.) A separate medical consent form will be emailed for parent signature. Please enter valid data.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Child Grade Entering Sept. 2026 REQUIRED Please fill out this field.
- Child Gender REQUIRED Please fill out this field.
- Does your child have allergies? REQUIRED Yes No Please fill out this field.
- If yes, please provide details. Please enter valid data.
- Does your child require medication? REQUIRED Yes No Please fill out this field.
- If yes, please provide details. (i.e., Epi pen, etc.) A separate medical consent form will be emailed for parent signature. Please enter valid data.

Mother First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Father First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Contact Information

Child's Home Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Primary Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Primary Email Address REQUIRED Please fill out this field. Please enter an email address.

Secondary Phone Number Please enter a phone number.

Secondary Email Address Please enter valid data.

Home Parish REQUIRED Please fill out this field.

Emergency Contact Information

Emergency Contact First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Relationship REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Cell Phone REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Home Phone - If applicable Please enter valid data.

Emergency Medical Consent Form: I request Resurrection Parish, 651 Millbrook Avenue, Randolph, NJ 07869, to accept my child into its Vacation Bible School. I do hereby give permission to the personnel (parish staff and volunteers) of Resurrection Parish to administer, secure and/or authorize such emergency medical care and/or treatment, including, but not limited to, the use of an Epi pen, as my child may require while under the supervision of said parish personnel. I also agree to pay all costs and fees related to said emergency medical care. I release, hold harmless and discharge Resurrection Parish, its officers, employees and personnel from any and all liability, claims, losses, damages, costs, and/or expenses resulting from said emergency medical care, including, but not limited to, the use of an Epi pen.

Emergency Consent REQUIRED I Agree Please fill out this field.

Website Photo/Video/Social Media Waiver: I give my permission for the posting of photos or video on the Resurrection Parish Website and Facebook/Instagram account that may contain my son/daughter. Photos/Video may include a caption describing the activity. Photos or video will not contain the last name, home address, or telephone/cell number for any child involved. This permission will be in effect until I request a change in writing.

Social Media Consent REQUIRED I Agree I Decline Please fill out this field.

Resurrection Parish

651 Millbrook Ave.
Randolph, NJ
973-895-4224
info @resurrectionparishnj.org

2026 Vacation Bible School Camper registration

august 10-14, 9:00-12:30pm daily

summer vacation bible school experience what we are all about!

questions about vbs? contact us