Good News Club Form

Child's Name

School Campus

Grade

Gender

Birth Date

Age

Address

List any security/custody issues with this child:

List any special needs (ADD, Asperger's, Dyslexia, etc.):

Child's allergies (peanuts, chocolate, etc.)

Family Email

This address will receive a confirmation email

Home Phone

Dad's Work/Cell Phone

Mom's Work/Cell Phone

Church you belong to?

Emergency Contact 1 (Relation to Child)

Emergency Contact 1's Phone

Emergency Contact 2 (Relation to Child)

Emergency Contact 2's Phone

PERMISSION FOR PICK UP - In addition to those listed above, the following people are allowed to pick up my child:

Print Full Name (Relation to Child)

Phone

Print Full Name (Relation to Child)

Phone

Indicate how your child will get home on club day

My child will be a car rider My child will walk home.

Who should be called first regarding pick up?

By typing my name below, my child is allowed to attend the Good News Club at Eustace Primary School after school EVERY Monday when there has been a full day of school. Good News Club will run from September 8, 2025 through April 27, 2026. I understand it is my responsibility to pick up my child at 4:30PM and failure to do so will jeopardize my child's continued participation.

Name

Today's Date

OPTIONAL Photography and Video Release

Child Evangelism Fellowship may, from time to time, document the activities of the ministry with photos or videos.

By typing my name below, I hereby assign and grant the Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership, use and proceeds of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational and promotional purposes.

Parent/Guardian (First and Last Name):

Today's Date:

Child's Name:

Email a copy of my submission to

Description

Please fill out this form and click submit.

Good News Club Form

Description

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