CEF of south Central

Chillicothe Club Registration - 2024

Good News Club® Registration Form

About Good News Club

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

Children 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, background checked, and trained as required by Child Evangelism Fellowship® Child Protection Policy to ensure your child’s safety.

Who Can Attend?
Boys and girls, 3rd through
6th grade, regardless of religious background.
Parents are welcome to attend with child.

Sponsored By: Child Evangelism Fellowship of Ohio, Inc. South Central Chapter

What Day and Time?

Time—Start: 2:15 PM End: 3:45 PM

Dates: Every Thursday

••••••only on full days of school••••••

From February 8, 2024 to March 22, 2024

Location: Chillicothe Intermediate School

Hosted and Conducted by: Great City Church

Contact: Pastor Mike Culp – (740) 601-7234

Chillicothe Good News Club Registration Form - 2024

***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 time. Our policies do not allow GNC workers to remain after club. If your child is not picked up immediately after club three times throughout the school year. *COMPLETED AND SIGNED PERMISSION SLIPS ARE REQUIRED*

Child's Name:(Required)

First and Last Name

(child’s name) is allowed to attend the Good News Club at Chillicothe Intermediate School. The Club will run from February 8 to March 21, 2024. I understand it is my responsibility to pick up my child at 3:45 pm and failure to do so will jeopardize my child’s continued participation.

Parent /Guardian Signature(Required)

I agree that this signature will be an electronic representation of my signature for all purposes when I use them on documents, including legally binding contracts - just the same as a wet ink signature on paper.

Date(Required)

Indicate how your child will get home on club day.(Required)

My child will be picked up after Good News Club.

My child will walk home after Good News Club.

My child is registered for an will attend (name of program for) extended day/after-school program.

Child's Name:(Required)

First Last

School:(Required)

Homeroom teacher:(Required)

First Last

Grade:(Required)

Choose one:(Required)

Female

Male

Birth Date:(Required)

Age:(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

List any security/custody issues with this child?(Required)

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

Child's Allergies (peanuts, chocolate, etc.)(Required)

Family Email:(Required)

Home Phone:(Required)

Parent 1/Guardian 1:(Required)

First Last

Work/Cell phone:(Required)

Parent2/Guardian2:(Required)

First Last

Work/Cell Phone:(Required)

Church(Required)

Is either parent/guardian in the military?(Required)

Yes

Emergency Contact 1:(Required)

First Last

Phone:(Required)

Emergency Contact 1:(Required)

First Last

Phone:(Required)

PERMISSION FOR PICK UP - in addition to those listed above, the following people are allowed to pick up my child:(Required)

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.

Parent/Guardian Signature:

First Last

Date

Child's Name:

First Last

CEF of south Central

Chillicothe Club Registration - 2024

Good News Club® Registration Form

Chillicothe Good News Club Registration Form - 2024

OPTIONAL Photography and Video Release

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