Good News Club Registration Form

Good News Club Registration Form

Sponsored by Child Evangelism Fellowship of NC Western Piedmont
This is not an activity of the school or school district.
What Good News Club location are you registering for?
Student Release/Pick up:
Parental permission
Check here to show how your child will be picked up at the conclusion of the GNC program on club day:
Parent/Guardian Signature:
Note: your typed signature is legally binding. If you prefer to give a written signature, you may print your name here and then write your signature in the box below.
Parent/Guardian Written Signature (optional)
Child Evangelism Fellowship may occasionally take photos at Good News Club or other ministry events for the purpose of promotion and education. If you would allow photos of the children on this form to be posted on official CEF webpages and printed in promotional brochures and newsletters for CEF, please sign the optional photo release below.
Photo Release: (optional)

I grant permission to Child Evangelism Fellowship to use photographs of my minor child or children listed below, in print or online materials designed for promotion, informational or educational purposes related to Child Evangelism Fellowship. I understand that my child’s name and location will not be used in any promotions.
Parent/Guardian Signature:
Note: your typed signature is legally binding. If you prefer to give a written signature, you may print your name here and then write your signature in the box below.
Parent/Guardian Written Signature (optional)
Child's Information:

You may register up to 4 children at one time if they share the same family information (i.e. same address, emergency contacts, etc.)
CHILD 1
Name

First NameLast Name
Gender
Grade
Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Homeroom Teacher
T-shirt size
Child's allergies
If none, leave blank
Life threatening
Treatment/special snack needed
- Name
  
  First NameLast Name
- Gender
- Grade
- Homeroom Teacher
- Birthday
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Age
- T-shirt size
- Child's allergies
  If none, leave blank
- Life threatening
- Treatment/special snack needed
- Name
  
  First NameLast Name
- Gender
- Grade
- Homeroom Teacher
- Birthday
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Age
- T-shirt size
- Child's allergies
  If none, leave blank
- Life threatening
- Treatment/special snack needed
- Name
  
  First NameLast Name
- Gender
- Grade
- Homeroom Teacher
- Birthday
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Age
- T-shirt size
- Child's allergies
  If none, leave blank
- Life threatening
- Treatment/special snack needed
- Family information:
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState (i.e. NC)
  
  Postal / Zip Code
- Phone Number
  Format: (000) 000-0000.
- You may communicate with me through:
- Primary Language
  
  Other
- Church (optional)
- Pastor (optional)
- Emergency Contacts
  
  Parent/Guardian: Please be sure to list yourself under emergency contacts if you will be picking your child(ren) up from club. Only individuals listed under emergency contacts and marked as "authorized for pickup" will be able to pick up the children listed on this form. Changes can be made to your child's pick-up list verbally or in writing. Please contact your team leader for questions about or changes to the pick-up list.
- CONTACT 1 (priority contact)
- Name
  
  First NameLast Name
- Phone Number
  Format: (000) 000-0000.
- Email
  example@example.com
- Relation to child
- If other, please specify
- Name
  
  First NameLast Name
- Phone Number
  Format: (000) 000-0000.
- Email
  example@example.com
- Relation to child
- If other, please specify
- Name
  
  First NameLast Name
- Phone Number
  Format: (000) 000-0000.
- Email
  example@example.com
- Relation to child
- If other, please specify
- Name
  
  First NameLast Name
- Phone Number
  Format: (000) 000-0000.
- Email
  example@example.com
- Relation to child
- If other, please specify
- Name
  
  First NameLast Name
- Phone Number
  Format: (000) 000-0000.
- Email
  example@example.com
- Relation to child
- If other, please specify
- GNC Discipline and Dismissal Procedures
- If you have difficulties reading the above PDF, please download or print to read.
- If you have concerns about your child being able to follow the discipline requirements above, please state those reasons below:
- Provide more information here concerning your child’s allergies:
- By signing below I state that I have read and agree to the above procedures regarding my child.
- Parent/Guardian Signature:
  Note: your typed signature is legally binding. If you prefer to give a written signature, you may print your name here and then write your signature in the box below.
- Parent/Guardian Written Signature (optional)
- Should be Empty: