Thank you for your interest in our community programs!
Please complete the form below to register your child in one of our classes for Fall 2016.
Please use this form only if you intend to make your payment by credit card (AMEX, Visa, MasterCard, or Discover). To pay by check, please download and complete this form.
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 I/my child am/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 Community Programs to obtain the necessary medical care for my child. If my child has allergies and I have provided an Epi-Pen to Rutgers, I authorize instructors trained in the use of Epi-Pen to administer it to my child if necessary. 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.
Rutgers Presbyterian Church
236 West 73rd StreetNew York, NY 10023
Church Office Hours
9 AM - 5 PM, Monday - Friday
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