Butler Acres Good News Club Registration Form

1

Good News Club is an exciting, fun-filled 1 1/2 hour after-school club held once a week.

It includes:

Dynamic Bible Lessons
Creative Learning Activities
Inspiring Missionary Stories
Meaningful Songs
Life-changing Scripture Memory

Your child will learn:

Respect for Authority
Character Qualities
Moral Values
Biblical Principles

Who teaches the club: Specially trained Christians concerned for the spiritual well-being of your child teach the club. All club workers are screened as required by CEF's child protection policy to ensure your child’s safety.

2

Sponsored by: Child Evangelism Fellowship

Hosted and Conducted by: Sue Healey: 503-748-4509

Time: After School 3:30 - 5:00 pm.

Dates: Every Thursday starting Fall Session: Oct: 23, 30 Nov. 6, 13, 20 Dec. 4, 11 Winter Session: Feb. 5, 12, 26 Mar. 5, 12, 19

Place: Library

Who can attend: All boys and girls grades K - 5, regardless of religious background. Parents are welcome to attend with child.

friendly tip:

SCREENSHOT this page to keep track of the dates! :)

3

Parent /Guardian: Your child must be picked up immediately after the club ends. Our policies do not allow Good News Club teachers or helpers to remain at school after club. If your child is not picked up immediately after club three times throughout the school year, he/she will not be allowed to continue attending the club. Thank you.

The United States Constitution requires schools to respect the right of all external organizations to distribute flyers to students at school if the school permits any such organization to distribute flyers. Accordingly, the school cannot discriminate among groups wishing to distribute flyers at school and does not endorse the content of any flyer distributed at school. The school encourages parents to assist their children in making choices appropriate for them.

This is not an activity of the school.

Please fill out the remainder of this application and submit!

4

Enter Your Child's Name Below:* This field is required.

5

I understand it is my responsibility to pick up my child at 5:00 pm on the dates listed above, and failure to do so will jeopardize my child's continued participation.* This field is required.parent/guardian signature

6

Date* This field is required.

Date

7

Check the box to show how your child will get home on club day:* This field is required.

My child will be picked up in the car line

My child will walk home

My child goes to the school's extended day/after-school program

8

Is either parent in the military?

Yes

No

9

I grant Lower Columbia CEF & WA CEF the right to use photographs of this child on the website or newsletter to advertise and promote CEF Good News Club

Yes

No

10

Guardian Initials* This field is required.

11

Child's First Name* This field is required.

12

Child's Last Name* This field is required.

13

Child's Birthdate* This field is required.

Date

14

Age* This field is required.

15

Child's Gender* This field is required.

Male

Female

16

Homeroom Teacher* This field is required.

17

Grade* This field is required.

18

Parent First Name* This field is required.or guardian

19

Parent Last Name* This field is required.or guardian

20

Email* This field is required.

21

Home/Main Phone* This field is required.

22

Dad's Cell/Work Phone

23

Mom's Cell/Work Phone

24

Address* This field is required.

25

City* This field is required.

26

Apt

27

Emergency Contact Person 1* This field is required.

28

Emergency Contact Person 1 Phone* This field is required.

29

Emergency Contact Person 2

30

Emergency Contact Person 2 Phone

31

Church

32

Pastor

33

Childs Allergies Dairy, Gluten, Peanuts, Chocolate, etc.

34

Childs Special Needs

35

This person is allowed to pick up my child if I'm not able:* This field is required.

36

Phone* This field is required.Additional Pickup person phone #