Children’s Ministry Online Registration Form

Please use this form to register a child with the CITC Children’s Ministry. A completed form is required for each child to attend, even for one day. Thank you for helping us keep all of our Church In The City kids safe.

CITC Children's Ministry Registration

Please fill out this form if you plan to have a child (birth-6th grade) in the Church In The City Children's Ministry. A form must be filled out each year and before your child attends a class.

Child's Name*
First Last
Nickname (if any)
Child's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone Number
Date of Birth*
Grade in the fall of the current calendar year*
Allergy/Dietary Restrictions/Needs*
List child's allergies, dietary restrictions and dietary needs. If there are none, please state "none" to acknowledge and confirm there are none, to your knowledge.
1st Parent or Guardian
Please provide general information about first parent or legal guardian.
1st Parent/Guardian Name*
First Last
Relationship to child*
Does the child reside with this person?*
- Yes, full time
- Yes, part time
- No
- Other
Email*
Cell Phone*
1st Parent/Guardian Address (provide only if different from child's address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
2nd Parent or Guardian
Please provide general information about second parent or legal guardian, if applicable.
2nd Parent/Guardian Name
First Last
Relationship to child
Does the child live with this person?
- Yes, full time
- Yes, part time
- No
- Other
Email
Cell Phone
2nd Parent/Guardian Address (provide only if different from child's address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Authorized Pickup Name(s) & Relationship to Child*
Please list all individuals that are authorized to pickup your child and their relationship to child. If child is to be picked up by a sibling, the sibling must be at least 13 years of age and listed above.
Photograph Authorization
By filling out the information below, you agree to authorize Church In The City, hereafter referred to as "Company," to publish photographs taken of yourself and/or the minor child(ren) listed below, and your names and likenesses, for use in Company print, online and video-based marketing materials, as well as other Company publications. You, hereby, release and hold harmless the Company from any reasonable expectations of privacy or confidentiality for yourself and for the minor child(ren) listed below associated with the images specified above. Further, you attest that you are the parent or legal guardian of the child(ren) listed below and that you have full authority to consent and authorize the Company to use their likeness and names. You further acknowledge that participation is voluntary and that neither you nor the minor child(ren) will receive financial compensation of any type associated with the taking or publication of these photographs or participation in Company marketing materials or other Company publications. You acknowledge and agree that publication of said photographs confers no rights of ownership or royalties whatsoever. You, hereby, release the Company, its contractors, its employees and any third parties involved in the creation of Company publications, from liability for any claims by you or any third party in connection with your participation or the participation of the minor child(ren) listed below.
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship to the child(ren) listed below
Names of child(ren) you are giving photograph consent to
Photograph Consent Refusal
- I do not wish my child(ren) to be in CITC publications or posts.
Please check box above if you refuse photograph consent. We will not publish or post any pictures with your child(ren)'s images.

Children’s Ministry Online Registration Form

CITC Children's Ministry Registration

1st Parent or Guardian

2nd Parent or Guardian

Photograph Authorization