GOOD NEWS CLUB Herrin

GOOD NEWS CLUB at Herrin Elementary School

Thursdays (only on full days of school) November 7, 2024- December 12, 2024 & January 30, 2025-February 27, 2025
Thank you for your interest in the after-school Good News Club. Every child who attends the GNC must have a completed and signed registration by a parent or legal guardian. Children 2nd-5th graders are invited to participate.

Please submit one form per family.
Child's Name (first and last)*
Child's Name (first and last)
Child's Name (first and last)
Club Details: Club meets immediately after school at the Herrin Elementary School in the New Gym on Thursdays (only on full days of school) November 7, 2024- December 12, 2024 & January 30, 2025-February 27, 2025.

Club will begin after school and ends at 4:00 PM.

All volunteers at GNC have been screened according to the Child Protection Policy of Child Evangelism Fellowship.

Contact:

For more information, please contact Colette 618-694-2549 or Robert 618-889-3591
Homeroom teacher*
Birth Date

MonthDayYear
Date
Grade*
Age*
Street Address
Apt. #
City
State
Zip
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*
example@example.com
Main phone*
Dad's work/cell phone
Mom's work/cell phone
Church
Is either parent in the military? Circle Y/N
Emergency Contact 1 (Relation to child)*
Emergency Contact 2 (Relation to child)*
Indicate who will be picking up your child on club day. Who should be called first regarding pick up?*
I am aware and will pickup my child after Good News Club at 4:00 pm every Thursday there is Good News Club. Failure to do so will result in my child/children not being able to attend club anymore.*

I understand
My children, listed on this form, have permission to attend the CEF Good News Club.
(Signature of parent or guardian)*

Clear
(Date)*

MonthDayYear
Date
(Printed Name)*
OPTIONAL 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.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Parent/Guardian Printed Name
Child's Name
Should be Empty:

GOOD NEWS CLUB at Herrin Elementary School

Thank you for your interest in the after-school Good News Club. Every child who attends the GNC must have a completed and signed registration by a parent or legal guardian. Children 2nd-5th graders are invited to participate.