Roosevelt GNC Registration Form 2024-2025

Please use this form to register your child for the Roosevelt Good News Club. Thank you!

Time: 3:00-4:15 p.m.
Date: Every Monday on full days of school, October 21, 2024 to May 5, 2025
Location: Roosevelt Elementary School Music Room.
Sponsored by: Child Evangelism Fellowship
of Klamath-Lake
Contacts: Renee Cedarleaf (541) 883-7272 & Earl Van Order (541) 331-1909

Child's Name

School

Grade

Gender

Male Female

Birthdate

Age

Address

Please list any allergies, special needs, or custody issues.

Church

Parent/Guardian Name(s)

Is either parent/guardian in the miltary?

Yes No

Parent 1 Email

This address will receive a confirmation email

Parent 2 Email

Parent 1 Phone

Parent 2 Phone

Preferred Contact Method

Text Email Call

Emergency Contact 1 (Name, number, relation to child)

Emergency Contact 2 (Name, number, relation to child)

How will your child get home on club day?

My child will be picked up. My child will walk home.

In addition to those listed above, please list names and phone numbers of any other people who have permission to pick up your child from club.

My child named above is allowed to attend the Good News Club at Roosevelt Elementary School every Monday there is a full day of school. Club will run from October 21st, 2024 to May 5th, 2025. I understand that it is my responsibility to pick up my child at 4:15 p.m. and failure to do so will jeopardize my child’s continued participation.

On electronic forms, your typed signature carries the same weight as your written signature.

Signed:

Today's Date:

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.

On electronic forms, your typed signature carries the same weight as your written signature.

Signed:

Today's Date:

Child's Name

Description

Good News Club® is an exciting, fun-filled weekly club for kids in which the Bible is clearly taught with songs, stories, games, and more!

Your child will learn:
•God loves them
•Every person has value
•How God can help them do the right thing, find victory in hard times, show love to others, etc.

Who teaches the club?
GNC teachers are specially trained Christians who are concerned for the well-being of your child. All club workers are screened as required by the Child Evangelism Fellowship® Child Protection Policy to ensure your child’s safety.

Who can attend?
Boys and girls, K-6th grade, regardless of religious background. Parents are welcome to attend with their child.

Roosevelt GNC Registration Form 2024-2025

Description

Please Fix the Following