Sara Harp Minter Elementary 2021-2022 Good News Club Student Registration Form

Who can attend? All boys and girls, grades Kindergarten- 5th grade, regardless of religious background

When: Every Monday on full days of school beginning August 23, 2021 and ending May 9, 2022

Time: 2:20-4:00pm

Where: Media Center

Hosted by: Lisbon Bapist Church, www.LisbonBaptistChurch.com

Parents are also welcome to attend with your child, however interaction with other children is not allowed without a background check on file with Child Evangelism Fellowship.

Please note that registrations need to be completed by Wednesday in order to attend club the next week.

Acknowledgements

My child (named below) is allowed to attend the Good News Club at Sara Harp Minter Elementary School, every Monday after school

Yes No

I understand that there will be no clubs on half days and school holidays. Club will run until May 9, 2022. Clubs will run concurrent with the school calendar.

Yes No

I understand it is my responsibility to pick up my child at 4:00PM and failure to do so will jeopardize my child’s continued participation

Yes No

I understand CEF does not provide transportation to the Good News Club (GNC™) location. Parents must arrange transportation to the GNC location and must pick up each child promptly at GNC end time. Our policies do not allow GNC teachers or helpers to remain 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.

Yes No

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form. You are agreeing that you have read and understand the statements listed above.

Your Name

Child's Information

Child's LEGAL Name

Nickname

Birthdate

Homeroom Teacher

Grade

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Gender

Male Female

Address

County

Butts Coweta Fayette Henry Meriwether Pike Rockdale Spalding

Are there any security / custody issues with this child?

Yes No

Security - Please explain

Does your child have any special needs we should be aware of (ADD, Autism, Dyslexia, etc.)?

Yes No

Please explain special needs:

Does your child have any allergies (peanuts, chocolate, etc.)?

Yes No

Please explain allergies:

Indicate how your child will get home on club day

My child will be picked up after Good News Club My child will walk home after Good News Club My child is registered for and will attend extended day/after-school program

Contact Information

Please enter the BEST mobile number to reach someone.

Phone

Please enter the BEST email address for correspondence with your child's Good News Club

This address will receive a confirmation email

Parent/Guardian 1 Full Name

Parent/Guardian 1 Phone

Parent/Guardian 2 Full Name

Parent/Guardian 2 Phone

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:

Pickup Person #1 Name

Pickup Person #1 Phone

Pickup Person #2 Name

Pickup Person #2 Phone

Additional Information

Is either parent in the military?

Yes No

Church your family attends, if any

OPTIONAL Photography and Video Release

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.

I approve the above Photography and Video Release

Yes No

Child's Name

If Yes, name of parent giving permission (if No, enter N/A)

Sara Harp Minter Elementary 2021-2022 Good News Club Student Registration Form

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