Children’s Ministry Online Registration Form

Please use this form to register your child with the CITC Kid’s Ministry. Your child will need to fill out this form to use put your child in the ministry for even a day. Thank you for helping us keep all our Church in the City kids safe.

Children's Ministry Registration

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

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth*
Grade in the Fall of 2018*
Home Phone Number
Nickname (if any)
1st Parent or Guardian
Please provide general information about one parent or legal guardian.
Name*
First Last
Relationship to the child*
Does the child live with this person?*
- Yes, full time
- Yes, part time
- No
- Other
Email*
Cell Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

This only needs to be filled out if it is different from the address of the child.
2nd Parent or Guardian
Please provide general information about a second parent or legal guardian if applicable.
Name
First Last
Relationship to the child
Does the child live with this person?
- Yes, full time
- Yes, part time
- No
- Other
Email
Phone
Authorized Pickup*
Please list individuals that you will allow to pick up your child. If children are to be picked up by their siblings, the sibling must be 13 years old and listed above.
Photo Authorization
By filling out the information below, you agree to authorize Church in the City, hereafter refereed to as "Company," to publish photographs taken of yourself and or the minor children 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 children listed below associated with the images specified above. Further, you attest that you are the parent or legal guardian of the children 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 in voluntary and that neither you or the minor children will receive financial compensation of any type associate with the taken or publication of these photographs or participation in Company marketing materials or other Company publications. You acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. You hereby release the Company, it's contractors, its employees and any third parties involved in the creation of publication of Company publications, from liability for any claims by you or any third party in connection with your participation of the participation of the minor children listed below.
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship to the children listed below
Names of children you are giving Photo Consent to
Photo Consent Refusal
- I do not wish my children to be in CITC publications or posts.
Please check below if you would like to refuse Photo Consent. We will not publish or post any pictures with your children's images.

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Children’s Ministry Online Registration Form

Children's Ministry Registration

1st Parent or Guardian

2nd Parent or Guardian

Photo Authorization