GNC Registration Form

2023-2024 GOOD NEWS CLUB® REGISTRATION FORM

Note: Child cannot attend without signed permission form.
My child(ren), listed on this form, has my permission to attend the GOOD NEWS CLUB®. (There will be no clubs on half days and school holidays.) I understand it is my responsibility to pick up my child(ren) immediately at the end of club at 4:00 and failure to do so will jeopardize my child's continued participation. I also understand volunteers who are leading the club are not medically trained. Child Evangelism Fellowship® of South Carolina (CEF-SC) encourages participating church volunteers to follow the school’s safety guidelines in providing a safe atmosphere for your child’s participation.
On occasion, pictures/videos are taken during the club hour for publicity purposes only. Please check your preference:

Yes, I agreeNo, I do not agree
What site will your child be attending?

Chester Park - TuesdayRichmond Drive - WednesdayClover School District YMCA - MondayLake Wylie YMCA - ThursdayVirtual Club - Tuesday
CHILD INFORMATION
First Name Last Name Preferred Name Birthdate Age Teacher Street Address Address Line 2 City State Zip Email Phone Number
Your email address will NOT be used for non-club purposes! Please include so we may send you important GNC reminders.
Food Allergies * Learning Needs
Medical Needs Church Child Attends
Pastor
SIBLINGS ATTENDING GOOD NEWS CLUB
First Name Last Name Preferred Name Birthdate Age Teacher
Food Allergies * Learning Needs
Medical Needs Church Child Attends
Pastor
First Name Last Name Preferred Name Birthdate Age Teacher
Food Allergies * Learning Needs
Medical Needs Church Child Attends
Pastor
First Name Last Name Preferred Name Birthdate Age Teacher
Food Allergies * Learning Needs
Medical Needs Church Child Attends
Pastor
Contact Information - Please include 4 contacts for your child(ren) and check type of Authorization.
Mother/Guardian
First Name Last Name Phone Number
Father/Guardian
First Name Last Name Phone Number
Other Authorized Contact
First Name Last Name Phone Number
Other Authorized Contact
First Name Last Name Phone Number
Check here to show how your child will get home on club day

My child will be picked up in the car line.My child should be taken to "extended day program".My child will walk home.Not Applicable (Virtual club or YMCA locations)
Dismissal or Car Tag Number:
Parent/Guardian Signature:*

Typed name will serve as signature Clear
Date*

MonthDayYear
Should be Empty:

2023-2024 GOOD NEWS CLUB® REGISTRATION FORM