Good News Club Student Registration

Good News Club at Longfellow Elementary School

Meeting Time: 3:30 pm to 5:00pm

Dates: Every Monday — Fall 2024 Dates TBD

If you have any questions, contact Club Coordinator Emmilee Bean at farmgirl.dogs@gmail.com or (319) 404-0684.

Child's Information

Child's Name

School

Homeroom Teacher

Grade

Sex

Male Female

Birthdate

Age

List any security/custody issues with this child

List any special needs (ADD, Asperger’s, Dyslexia, etc.)

Child’s allergies (peanuts, chocolate, etc.)

Indicate how your child will get home on club days

My child will be picked up after Good News Club My child will walk home after Good News Club My child will attend the school's extended day/after school program

Would you like to know about other CEF family events?

Yes No

Contact Information

Address

Parent1/Guardian1 Email

This address will receive a confirmation email

Parent1/Guardian1 Cell Phone

Parent2/Guardian2 Email

This address will receive a confirmation email

Parent2/Guardian2 Cell Phone

Address

Church (if any)

Is either parent/guardian in the military?

Yes No

Emergency Contact 1 Name

Emergency Contact 1 Phone

Emergency Contact 2 Name

Emergency Contact 2 Phone

PERMISSION FOR PICK UP - in addition to those listed above, the following people are allowed to pick up my child:

Alternate Pick Up 1 Name

Alternate Pick Up 1 Phone

Alternate Pick Up 2 Name

Alternate Pick Up 2 Phone

Alternate Pick Up 3 Name

Alternate Pick Up 3 Phone

OPTIONAL Photography and Video Release

Child Evangelism Fellowship® may, from time to time, document the activities of the ministry with photos or videos. Your choice does not affect your child's ability to participate in a Good News Club or any other CEF activity.

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 advertising and promotional purposes.

Yes, I Agree No, I Disagree

Certification

My child (named above) is allowed to attend the Good News Club at the place and times listed above. I understand it is my responsibility to pick up my child at the end time noted above, and failure to do so will jeopardize my child’s continued participation.

Note: On digital forms, your typed signature carries the same weight as your written signature.

Parent/Guardian Signature (Full Name)

Date

Good News Club Student Registration - Longfellow

Description

Good News Club Student Registration - Longfellow

Description

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