Fill out the form below to add additional students if you've already completed this form for one of your children.

    Student Information
    Program Attendance
    Our after school programs begin at 4:00pm each afternoon Monday - Friday. Camp starts at 1pm each afternoon Monday - Friday. Young Life is on Tuesdays at 6:30pm. Please fill out the below information for your child accordingly.
    Medical Information
    Please fill out the section below as thoroughly as possible to help us best serve your child.
    School Information
    We try to work with each teacher to give your child academic support. Please complete all the information below.

    Permissions & Agreements

    Prior to your child starting program, you will be asked to sign the following agreements.
    • I give my permission to the school district to release my child's records to Hartford City Mission.
    • I understand my child may be photographed or recorded on video to be used for memorabilia and program promotion. You have my permission to photograph and videotape my child or display samples of his/her work.
    • I understand that my child may need to be transported to various sites within the state of Connecticut for field trips and other programmatic events. Children will only be transported by licensed staff. I give Hartford City Mission staff and/or volunteers permission to transport my child for program activities and release the staff and/or volunteers from any liability.​
    By hitting the submit button below you are acknowledging agreement with the following statements:
    1. I understand that placement in this program is not guaranteed and space is limited.
    2. I understand that in order for a child to have an excused absence, I must inform the program by 3pm.
    3. I understand Hartford City Mission reserves the right to remove students based on conduct and/or attendance.
    4. I understand that I am responsible for my child's transportation to and from program.
    5. I understand that Hartford City Mission's programs use lessons that are Biblically based and my child will be exposed to and participate in Christ-centered activities.
    6. I understand that my registration is not complete until all paperwork has been completed and submitted including a physical dated within the last 2 years.
Hartford City Mission, P.O. Box 320397, Hartford, CT 06132-0397  p. 860.246.0132