Greensboro Academy Good News Club Permission Form

Is your child free on Tuesday afternoons? Are you looking for a fun and exciting afterschool activity to engage your child? Child Evangelism Fellowship will be hosting an afterschool program called the Good News Club, beginning September 13th, on Tuesday afternoons from 3:30pm - 4:30pm on the full days school meets. This club includes Bible lessons, music, snack, friendships, and volunteers from Charity Baptist Church to encourage growth in your child! Make sure to invite your friends!

Parent's Name*

First NameLast Name

Parent's Name

First NameLast Name

Child's Name*

First NameLast Name

Date of Birth*

Gender*

MaleFemale

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Dad's work/cell #

Please enter a valid phone number.

Mom's work/cell #

Please enter a valid phone number.

Home Phone #

Please enter a valid phone number.

School*

Homeroom Teacher*

Grade *

Church you attend

May we send you information via text?*

YesNo

Best number to text

Emergency Contact 1*

First NameLast Name

Relationship to child*

Phone Number*

Please enter a valid phone number.

Emergency Contact 2*

First NameLast Name

Relationship to child*

Phone Number*

Please enter a valid phone number.

List any security/custody issues with this child

List any special needs (ADD, Asperger's, Dyslexia, Etc)

Child's allergies (Peanuts, Chocolate, Etc)

Permission to pickup other than listed above

First NameLast Name

Relationship to child

Phone Number

Please enter a valid phone number.

Permission to pickup other than above

First NameLast Name

Relationship to child

Phone Number

Please enter a valid phone number.

Who should be called first regarding pickup*

First NameLast Name

My child*

will be picked up after Good News Club.will go to the after school program at Greensboro Academy.

My child, Student First Name* Student Last Name* is allowed to attend the Good News club at Greensboro Academy on every Tuesday (beginning September 13th, 2022) that there is a full day of school. Club will run from 3:30 PM until 4:30 PM . I, Parent First Name* Parent Last Name* , understand it is my responsibility to pick my child up at 4:30 PM or have them attend the afterschool program and failure to do so will jeopardize my child's continued participation. Date*

Child Evangelism Fellowship may, from time to time, document the activities of the ministry with photos or videos. I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership, use, and proceeds of all photographs or videos of me or my minor child, without reservation or limitation, including use of photographs or video of my or my minor child for, but not limited to, advertisting, educational, and promotional purposes.

I, Parent First Name Parent Last Name , understand that I am giving photo and video consent as listed above for my child, First Name Last Name do understand that typing my name is valid as a signature and issue my consent on Date .