Good News Club Registration

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This registration form is for the Good News Club that meets at the Shapleigh Memorial School.

Day: Tuesdays

Time: 3:00 - 4:30 pm

Location: Shapleigh Memorial School Library

Who can attend?

Boys and girls, K-5th grade, regardless of religious background.

Home schoolers are also welcome.

Parents are welcome to attend with their child.

The club will run from October 10, 2023 - May 21, 2024, when school is in session and it is a full school day.

Sponsored by:

Child Evangelism Fellowship of Southern Maine

South Portland Office: (207) 741-5211 [Tuesday and Friday]

Club leader:

Mrs June Robertson

(207) 324-8588

mumbletrain@yahoo.com

Hosted and Conducted by:

First Baptist Church of Shapleigh

600 Shapleigh Corner Rd

Shapleigh, ME 04076

Email *

Child's Name (first and last) *

Male or Female *

Male

Female

Birth Date

Age *

Street Address, City, State, Zip) *

List any special needs (DD, Asperger's, Dyslexia, etc.)

Child's allergies (peanut, gluten, chocolate, etc.)

Parent/Guardian *

Parent/Guardian Phone Number *

Emergency Contact and Relation to Child *

Emergency Contact phone number *

Do you have a home church that you regularly attend?
If "yes", what is the name of the church?
If "no", would you be interested in receiving information about First Baptist Shapleigh?

Permission for Pick Up.
In addition to those listed above, the following people are allowed to pick up my child:
(Please include full name, relation to child, and cell phone number) *

Indicate how your child will get home on club day.
If necessary, who should be called first regarding pick up? *

My child will be PICKED UP after Good News Club

My child will WALK HOME after Good News Club

Please notify the school office in writing that the child has permission to attend Good News Club.

**By submitting this form, you the parent/guardian of the above-named participant, agree to accept all liability for participation in GNC related to COVID-19** *

Yes, I understand that I must contact the school and accept liability relating to COVID-19

OPTIONAL: Photography and Video Release
Child Evangelism Fellowship (the parent organization of Good News Club) 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. *

Yes, I give permission for CEF to use photos and/or videos in such a manner

No, I do not give permission for CEF to use photos and/or videos in such a manner

A copy of your responses will be emailed to the address you provided.

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