5-Day Club Student Registration Form

5-Day Club Student Registration Form
Which 5 Day Club location will your child be attending?
- Does your child regularly attends a Good News Club/JYou Connection Club?
- Child's Full Name
  
  First NameLast Name
- Child's Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Does your child have any allergy? Please explain.
  If your child does not have allergies, please type "N/A"
- Parent's Full Name
  
  First NameLast Name
- Parent's Email
  example@example.com
- Parent's Contact
  Please enter a valid phone number.Format: (000) 000-0000.
- Affiliated Church
  If your family does not have a home church, please type "N/A"
- In addition to the parent listed above, Emergency Contact Full Name (Relationship To Child) & Phone Number
- PERMISSION FOR PICK UP: Please include Full Name (Relationship To Child) & Phone Number (or type "My child will walk home.")
  Multiple persons can be listed.
- 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.
Should be Empty: