Central Kids: Registration

We are so excited you are registering for your child to attend Central Kids! Please fill out this form for your household 8 weeks to 5th grade. Please click Add Adult to include the parents or guardians in the household. Click Add child for each child you have in your household.

If there are any medical/ allergy conditions, special needs or custody issues please make a note in the Medical note for each child's profile. Please type NO PHOTOS in the medical note for each child if you prefer not to consent to the Media Release. The medical note will be printed on the child's tag when attending.

Your name *

Email address *

Household members

Address *

Phone Number *

Media Release *

I consent that audio/video recording(s) made of my child's voice and or image may be used by Central Christian Church, for publicity and to promote Central Christian. I also consent that such pages, photos, or written transcripts of my child will be property of Central Christian Church. and they have the right to duplicate, to reproduce, and or use his/her image on their website free and cleat of any claim on my part.

Yes

Emergency authorization *

In the event of an emergency, I authorize first aid and/or medical treatment for this child and release Central Christian Church for any and all responsibility in connection therewith. Please type first and last name to give consent.