Clone of South Jacksonville Elementary Good News Club Registration Form

Child's Information

Sponsored by: Child Evangelism Fellowship of IL, Inc.

Contact: Sarah Donegan (307)-359-3934

Start Time: 12:30 PM

End Time: 3:30 PM

Date: Wednesday, September 23, 2026

Location: Outdoor Event held at YMCA, Jacksonville, IL

Who can attend? All youth ages 11-14, regardless of religious background.

This is not an activity of the school or the school district.

Transportation is not provided. Students can walk from the school and walk home after the event. We will provide volunteers at the crosswalks to direct students to the event.

This event is free to all attendees. Registration is required. Event will include food,

games, activities,music and a Bible teacher. This is a kick-off to a new weekly

program, "Junior Youth Challenge" that will begin on Wednesday, September

30 after-school at Jacksonville Middle School.

Junior Youth Challenge® (JYC™) is a Bible club to help students ages 11-14 receive

the tools necessary to live out their faith anywhere, in any situation, no matter who’s

watching. In the club they will also build quality friendships; learn from leaders who

pray for them; and enjoy games, snacks, and uplifting music.

Child's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

#2 Child's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

#3 Child's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Parent's Name

First NameLast Name

Home Number

Format: (000) 000-0000.

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Church

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Does your child/children have any allergies, chronic illness, or medical conditions? If yes, please describe.

I hereby assign and grant to Child Evangelism Fellowship Inc., the ownership, use and proceeds of all photographs or video of my minor child for advertising, educational and promotional purposes.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

JYC Youth Kick-Off Registration