2024-2025 Good News Club Student Registration Form First Baptist Church of Springfield / Springfield Elementary

Who can attend? All boys and girls, grades 4th-5th (and younger school age siblings,) regardless of religious background. Parents are also welcome to attend with child, however interaction with other children is not allowed without a background check on file with CEF.

Acknowledgements

My child (named below) is allowed to attend the Good News Club at Springfield Elementary, every MONDAY after school.

Yes No

I understand that there will be no clubs on half days and school holidays. Club will run until April. Clubs will run concurrent with the school calendar.

Yes No

I understand it is my responsibility to pick up my child at 4:30 PM and failure to do so will jeopardize my child’s continued participation.

Yes No

I understand CEF does not provide transportation to the Good News Club (GNC™) 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 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.

Yes No

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form. You are agreeing that you have read and understand the statements listed above.

Your Name

Child's Information

Child's Legal Name

Preferred Name

Birthdate

Homeroom Teacher

Grade

4th Grade 5th Grade 3rd grade (younger sibling of 4th or 5th grade student only) 2nd grade (younger sibling of 4th or 5th grade student only) 1st grade (younger sibling of 4th or 5th grade student only) Kindergarten (younger sibling of 4th or 5th grade student only)

Gender

Female Male

Address

County

Bryan County Bulloch County Chatham County Effingham County Evans County Screven County

IF YOU ANSWER NO TO ANY OF THE QUESTIONS BELOW PLEASE PUT N/A IN 'EXPLAIN' SECTION. THANK YOU.

Are there any security / custody issues with this child?

Yes No

Please explain security/custody issues:

Does your child have any special needs we should be aware of (ADD, Autism, Dyslexia, etc.)?

Yes No

Please explain special needs:

Does your child have any allergies (peanuts, chocolate, etc.)?

Yes No

Please explain allergies:

Indicate how your child will get home on club day

My child will be picked up after Good News Club My child is registered for and will attend extended day/after-school program

Contact Information

Please enter the BEST mobile number to reach someone. Please note we may also send reminders/announcements via text message.

Phone

Please enter the BEST email address for correspondence with your child's Good News Club. Please note we may also send reminders/announcements via e-mail.

This address will receive a confirmation email

Parent/Guardian 1 Full Name

Parent/Guardian 1 Phone

Parent/Guardian 2 Full Name

Parent/Guardian 2 Phone

Emergency Contact 1 Full Name

Emergency Contact 1 Relation to Child

Emergency Contact 1 Cell Phone

Emergency Contact 2 Full Name

Emergency Contact 2 Relation to Child

Emergency Contact 2 Cell Phone

Permission for Pick Up

Below is a list of names allowed to pick my child up from Good News Club **Please include your name as a pick up person** Your child will only be allowed to ride home with the names you list below. We will check photo ID's to verify identity. Please note any changes you make with the school office regarding pick up of your child are not shared with us. You will also need to contact us with any needed changes in the future.

Pickup Person 1 Full Name

Pickup Person 1 Phone

Pickup Person 2 Full Name

Pickup Person 2 Phone

Is either parent in the military?

Yes No

Additional Information

Church You/Your Family Attends, if any

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.

I approve the above Photography and Video Release

Yes No

Child's Name

If Yes, name of parent giving permission (if No, enter N/A)

COVID Information

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. As a result, federal, state, and local governments and agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. We are doing everything we can to be compliant with all regulations and ensure your safety. We have put in place preventative measures to reduce the spread of COVID-19, but we cannot guarantee that you or family members will not become infected with COVID-19.

By participating in programs, services, and activities of Child Evangelism Fellowship of Georgia you agree to the following:

On behalf yourself and your children, you hereby release, covenant not to sue, discharge, and hold harmless Child Evangelism Fellowship of Georgia, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any such program, service or activity.

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form. You are agreeing that you have read and understand the statements listed above.

Parent/Guardian Name

2024-2025 Good News Club Student Registration Form First Baptist Church of Springfield / Springfield Elementary

Description

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