Good News Club® Registration
Thank you for your interest in Good News Club. Children K5-5th grade are welcome to attend with their parent’s permission.

You are registering your child to participate in the Good News Club at Pleasant Valley Elementary School.

This program, activity, product, or service is not sponsored by or affiliated with Washington County Public Schools.
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Email *
Street Address *
City, State Zip *
Church
Parent/Guardian 1 Name *
Parent/Guardian 1 Phone *
Parent/Guardian 2 Name
Parent/Guardian 2 Phone
Acknowledgement/Permission (check all that apply) *
Required
After club, my child(ren)... *
Parent/Guardian Signature (type full name to sign) *
Emergency Contact 1 Name *
Emergency Contact 1 Phone *
Emergency Contact 2 Name *
Emergency Contact 2 Phone *
Others Authorized to pick up child(ren) - List names and phone numbers
First Name *
Last Name *
Birthday *
MM
/
DD
/
YYYY
Grade *
Gender *
Security/custody issues? (If yes, please explain.) *
Food allergies or medical conditions? (If yes, please explain.) *
FYI
Questions? Please feel free to contact CEF Northwest Maryland by email: northwestmarylandcef@gmail.com.

Good News Club is a ministry of Child Evangelism Fellowship®. All CEF workers are screened as required by CEF’s Child Protection Policy.

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