POLO RIDGE ELEMENTARY
Good News Club Registration
Wednesdays, 3:45-5:00PM
February 18 - April 1, 2026
Child Information
Child's Full Name
*
Child's Grade
*
Home Room Teacher Name
*
Child's Gender
*
Please Select
Male
Female
Allergies
*
Please list known allergies. If none, type NA
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PARENT / GUARDIAN INFORMATION
Parent/Guardian Full Name
*
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Home Address
*
Please enter full address.
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
Full Name
Emergency Contact Number
*
Please enter a valid phone number.
Alternate Pick Up 1 (This person is permitted to pick up my child)
Full Name
Contact Number
Alternate Pick Up 2 (This person is permitted to pick up my child)
Full Name
Contact Number
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PERMISSION TO ATTEND GOOD NEWS CLUB
My children, listed on this form, have permission to attend the Good News Club after school club.
*
YES
NO
Photography and Video Release: 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 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.
YES
NO
Signature
Date
-
Month
-
Day
Year
Date
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