CSDR Good News Club Registration 2023-2024 (Complete one form for each child)

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This registers your child for CSDR Good News Club which is 3:30pm to 5:15 pm on full school days Wednesdays starting October 18th

Email *

Child’s First Name *

Child's Last Name *

Grade/Teacher : *

Choose one *

Male Masculino

Female/femenina

Birthdate *

YYYY

Address *

List any security/custody issues

List any special needs (ADD, Dyslexia, etc.)

List any allergies (peanuts, chocolate, etc.)

What church does your child attend, if any?

Child lives with mom, dad, or both; etc.

Mom’s name and home/work/cell phone numbers
*

Dad’s name and home/work/cell phone numbers
*

Emergency contacts or resident advisor who can pick up your child, relation to child, and phone number
*

In addition to those listed above (parents and emergency contacts), please list the names and phone numbers of anyone else allowed to pick up your child from Good News Club
*

Names and Grades of siblings who attend CSDR

I give permission for my child to attend CSDR Good News Club on Wednesdays. Please type YOUR name.

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 my 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:

Type your name below if you give permission.

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

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