Breaktime Registration

Breaktime Registration

If you would like to sign your child up to attend New City Breaktime 2017, please fill out the form below.
  • Please list any known allergies
  • Check all immunizations your child has received.
  • Please list child's medications, dosages and when to administer medication
  • I authorize my child to participate in any events on or off site with New City Neighbors
  • I authorize my child to ride in any vehicle driven by the New City Neighbors staff member or volunteer
  • I authorize my child to receive emergency medical care with the consent of New City Neighbors. I understand I will be responsible for any medical fees incurred.
  • I authorize my child to have their picture taken by New City Neighbors and used in publications and materials for NCN and its partners.