Good News Club® Registration Form
This club is for Dutch Neck Elementary School Students
Child's last name (If more than one child attending, please fill out form for each child.)
Your answer
Child's first name
Your answer
Child's mailing address
Your answer
Child's age
Your answer
Child's grade
Your answer
Child's homeroom teacher's name
Your answer
Parent/Guardian (1) name
Your answer
Parent/Guardian (1) email address
Your answer
Parent/Guardian (1) best phone number(s)
Your answer
Parent/Guardian (2) name
Your answer
Parent/Guardian (2) email address
Your answer
Parent/Guardian (2) best phone number(s)
Your answer
Emergency contact person
Your answer
Emergency contact person's phone number
Your answer
Check here to show how your child will get home on Tuesdays after club
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.
Name and best phone number of person (1) allowed to pick up my child if I'm unable
Your answer
Name and best phone number of person (2) allowed to pick up my child if I'm unable
Your answer
Does your child have any allergies, medical conditions or food restrictions we should know about? (If none, please write NA)
Your answer
House of worship you are currently attending (If none, please write NA)
Your answer
Today's date
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