2022-2023 Burch Elementary Good News Club Student Registration Form

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

When: Every Wednesday, beginning September 14, 2022 and ending April 26, 2023

Time: 2:25-3:30pm

Where: TBD

Hosted by: New Heritage Church of God, http://newheritage.church

Parents are also welcome to attend with your child, however interaction with other children are 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 Burch Elementary School, every Wednesday after school.

Yes No

I understand that there will be no clubs on half days and school holidays. Club will run until April 26, 2023. Clubs will run concurrent with the school calendar.

Yes No

I understand it is my responsibility to pick up my child at 3:30PM 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

Please explain security/custody issues:

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 Full Name

Emergency Contact 1 Relation to Child

Emergency Contact 1 Cell Phone

Emergency Contact 2 Full Name

Emergency Contact 2 Relation to Child

Emergency Contact 2 Cell Phone

PERMISSION FOR PICK UP

In addition to those listed above, the following people are allowed to pick up my child:

Pickup Person 1 Full Name

Pickup Person 1 Phone

Pickup Person 2 Full 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)

COVID-19 Release

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. As a result, federal, state, and local governments and agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. We are doing everything we can to be compliant with all regulations and ensure your safety. We have put in place preventative measures to reduce the spread of COVID-19, but we cannot guarantee that you or family members will not become infected with COVID-19.

By participating in programs, services, and activities of Child Evangelism Fellowship of Georgia you agree to the following:

On behalf yourself, you hereby release, covenant not to sue, discharge, and hold harmless Child Evangelism Fellowship of Georgia, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any such program, service or activity.

Parent/Guardian Signature

Description

Wednesdays 2:25pm - 3:30PM

Good News Club® is an exciting, fun-filled weekly club for kids in which the Bible is clearly
taught with songs, stories, games & more!

Children will learn:
•God loves them
•Every person has value
•How God can help them do the right thing, find victory in hard times, show love to others, etc.

Who teaches the club?
GNC teachers are specially trained Christians who are concerned for the well-being of your child. All club workers are screened as required by Child Evangelism Fellowship® Child Protection Policy to ensure your child’s safety.

Sponsored by: Child Evangelism Fellowship® of GA, Southern Crescent
www.CEFSouthernCrescent.org

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 or the school district.

2022-2023 Burch Elementary Good News Club Student Registration Form

Description

Please Fix the Following