2023- 24 Bethune ES Good News Club Registration

Please Read

By filling out this form, I (as parent or guardian) agree to allow my child to attend Good News Club at Bethune Elementary during the 2023-24 school year. I understand it is my responsibility to pick up my child immediately after club ends and failure to do so will jeopardize my child's continued participation.

By signing via electronic signature method you are agreeing the electronic signature will be given full legal effect under federal and state law as if it were hand written.

Date

Please give your email address and cell phone where we will send confirmation of this registration as well as any updates needed about club.

Parent's Name

This address will receive a confirmation email

Phone

Complete the following about YOUR CHILD.

Name

Address

Club Location

APS: Buthune Elementary

What would. your child prefer to be called inc club

Grade

Homeroom Teacher

Homeroom Number

Gender

Birthdate

Church You/Your Family Attends

Does your child have any allergies? If so, please explain

Does your child have any special needs you would like to make us aware? If so, explain. (*ADD, Autism, Dyslexia, etc.

Are there any security / custody issues with this child you would like us to be aware? If so, please explain.

Any other information we should be aware of:

Is there at least one member in the military?

Yes No

Additional Emergency Contacts

In case of an emergency the first contact will be the parent. If unable to contact the parent, these names/phones will be contacted in the order listed. If there is a second parent who should be contacted, please list them here.

#1 Contact Name

#1 Contact Phone

#2 Contact Name

#2 Contact Phone

#3 Contact Name

#3 Contact Phone

Authorized People to Pick Up My Child

Please provide the names and phone numbers of any additional persons you would allow to pick up your child after the club. This includes relatives, friends, and shared rides.

PIck-up Person #1 Name

PIck-up Person #1 Phone

Pick-up Person #2 Name

PIck-up Person #2 Phone

Photo Release

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.

Yes No

Signature

T-Shirt for Club

Would you like to purchase a Good News Club t-shirt for your child? This is optional but is a great way to show your support and for your child to feel a part of the Good News Club family. T-shirts are $13 each including applicable sales tax and $4 shipping for the first shirt (an additional dollar for each shirt after) to the address you entered above. If you need 2 or more of the same size, please make a note in the More Shirts field. Thank you.

Youth Sizes Y XS (6-8) Y Small (10-12) Y Medium (14-16) Y Large (18-20) Y XL (22-24) Adult Small Adult Medium Adult XL Adult 2Xl

More Shirts

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2023- 24 Bethune ES Good News Club Registration

Description

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