Child Registration

Name of School / Club Location

Child First Name

Child Last Name

Grade of Child

Child 2 First Name

Child 2 Last Name

Grade of Child 2

Child 3 First Name

Child 3 Last Name

Grade of Child 3

Child 4 First Name

Child 4 Last Name

Grade of Child 4

Any food allergies or medical conditions? Please type n/a or provide appropriate details.

Parent / Guardian First Name

Parent / Guardian Last Name

Parent / Guardian 2 First Name

Parent / Guardian 2 Last Name

Primary Phone Number

Secondary Phone Number

Home Address

City

State

Country

Zip Code

My children, listed on this form, have permission to attend the CEF Good News Club.

Yes

Parent / Guardian Signature

Date

Emergency Contact 1 First Name

Emergency Contact 1 Last Name

Emergency Contact 1 Phone Number

Emergency Contact 2 First Name

Emergency Contact 2 Last Name

Emergency Contact 2 Phone Number

My child will be (please select one):

NOTE: If your child is not picked up within 15 minutes of dismissal and we are unable to reach you or your emergency contacts, we will take your child(ren) to SafeKey. This requires that you pre-register your child(ren) for SafeKey. Please see the school office for registration forms. Your child's safety is our #1 concern. Questions? Call Marianne, Office Manager, or Colin, Director, at (702) 396-8363. Good News Club is a ministry of Child Evangelism Fellowship.

I agree

OPTIONAL: Photography and Video Release (Not required for club attendance)

I agree Not at this time

Photography Release Signature

Child Registration

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