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  • City on a Hill Youth Program Registration Form

    Parent / Legal Guardian Consent Form

  • Welcome and thank you for wanting your child(ren) to be a part of the Youth Program here at City on a Hill!

     

    Please take a few minutes to complete the registration information below. 

  • PARENT/LEGAL GUARDIAN INFORMATION:

  • Please take a minute to review the Guidelines and Code of Conduct your child(ren) will be expected to adhere to:

     
    Youth will NOT be allowed entry into the program until a completed/signed registration form is returned by a parent/guardian.

     

    Zero Tolerance Policy: Violating the Zero Tolerance Policy will result in immediate dismissal from the program and possible criminal charges. Parents will need to provide immediate transportation from the program in the event of dismissal.
    A. The possession of or threat of use of weapons.
    B. Bullying, fighting, and overtly aggressive behavior.
    C. The use of tobacco products, alcohol, drugs, or fireworks on the property.
    D. Theft or intentional destruction of property.

     

    Youth Center program hours: 
    A. School Year: Tuesday & Thursdays from 3:00pm - 6:30pm.
    B. Summer Hours: Tuesday, Wednesday & Thursday from 11:00am - 3:30pm

    Parents picking up children must pick them up no later than 10 minutes past closing at the 940 N. 23rd Street door.

     

    To ensure the health and safety of the children, if a youth is sick or has any symptoms that indicate a certain illness, he or she may not attend City on a Hill youth programs and will be sent home immediately. 

  • PARENTAL PERMISSION AND RELEASE:

    EMERGENCY MEDICAL RELEASE: In case of emergency, I give City on a Hill representative's permission to render first aid and/or seek treatment for my child(ren) in a medical care facility; I give the medical care provider permission to administer the necessary treatment, and I accept full financial responsibility for any services rendered.

    MEDIA RELEASE: By signing below, I give permission to City on a Hill to include photographs/videos of my child(ren) in promotional materials (including the organization's website and social media) used to increase awareness of City on Hill programs.

    LIABILITY RELEASE: By signing below, I absolve City on a Hill of any responsibility for any accident or injury to my child(ren) or caused by my child(ren) to others where neglect is not involved. Furthermore, I understand that City on a Hill can only be responsible for my child(ren) during days and times that he/she has been check-in and that City on a Hill will not be responsible for my child(ren) when he/she is traveling or walking to and from any City on a Hill activity.

    PROGRAM GUIDELINES: I acknowledge that I have read and agree to the above Program Guidelines that City on a Hill has established.
    ***Initial here:      Date:   Pick a Date

    I give my permission for my child(ren) to participate in the Children and Youth Programs at City on a Hill and will encourage my daughter/son to attend regularly and adhere to the guidelines and procedures of the program(s) my child(ren) is registered for.   

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  • CHILD REGISTRATION INFORMATION:

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