Warren T. Jackson Good News Club ® Student Registration Form
Good News Club is an exciting, fun-filled weekly club for kids including dynamic Bible lessons, creative learning activities, inspiring missionary stories, meaningful and fun songs, and life-changing Scripture memory. Your child will learn respect for authority, moral values, character qualities, and Biblical principles.

The club will meet from 2:30 to 4:00 on Monday afternoons.

Please use this form to register your child for the Good News Club after-school program.
Parents are also welcome to attend with child, however, interaction with other children is not allowed without a background check on file with CEF.
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Parent/Guardian
CEF does not provide transportation to the Good News Club location. Parents must arrange transportation to the GNC location and must pick up each child promptly at GNC end of 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. Thank you for understanding.
Child's name *
First and last name
Child's Grade *
Child's Homeroom Teacher *
Child's Gender *
Child's Birthdate *
MM
/
DD
/
YYYY
Home Street Address *
City *
State *
Zip Code *
Family Email *
Home Phone *
List any security/custody issues with this child
Dad's First and Last Name *
Dad's Phone *
Mom's First and Last Name *
Mom's Phone *
List any special needs your student may have (ADD, Asperger's, Dyslexia, etc.)
List any child allergies your student may have (peanuts, chocolate, etc.)
Emergency Contact #1 First & Last name *
Emergency Contact #1's phone number *
Emergency Contact #2 First & Last name *
Emergency Contact #2's phone number *
Indicate how your child will get home on club day (Choose One): *
Required
Additional authorized pickup #1. In addition to emergency contacts, the following person (full name) is allowed to pick up my child:
Additional authorized pickup #1 cell phone:
Additional authorized pickup #2. In addition to emergency contacts, the following person (full name) is allowed to pick up my child:
Additional authorized pickup #2 cell phone:
Church
This is not an activity of the school or school district.
United States Constitution requires schools to respect the right of all external organizations to distribute fliers to students at school if the school permits any such organization to distribute fliers. Accordingly, the school cannot discriminate among groups wishing to distribute fliers 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.
Parent/Guardian Signature. By typing your name and clicking the "submit" button, you've electronically signed the record, according to the Uniform Electronic Transactions Act (UETA). *
Official 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.
Parent/Guardian Signature for Official Photography and Video Release. By typing your name and clicking the "submit" button, you've electronically signed the record, according to the Uniform Electronic Transactions Act (UETA).
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