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April - May 2024 Good News Club Registration - Solon Robinson City Park
Sponsored By:
Child Evangelism Fellowship - Northwest Indiana Chapter (219) 465-0201
Club Contact Person:
Mary Beth Pawlowski 219-616-1795
Dates: Wednesdays -
Apr 3, 17 and May 1, 15, 29, 2024
Location:
Solon Robinson City Park - across the street from Solon Robinson School
Time:
after school to 5 pm
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Email
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Your email
Student Last Name
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(* Fill out Section 2 for additional child in the same household)
Your answer
Student First name
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Your answer
Parents/Guardian Name(s)
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Your answer
Best phone number for Mom
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Your answer
Best phone number for Dad
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Your answer
Address (#, street, city, state, zip code)
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Your answer
Birthdate
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MM
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DD
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YYYY
Age
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Your answer
Home Church
Your answer
Emergency Contact Person other than yourself (Name & Phone)
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Your answer
Permission for pick-up --- In addition to myself, the following people are allowed to pick up my child: (Type full name/s and best phone number)
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Your answer
Choose below how your child will get home ON CLUB DATES
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Parents must arrange transportation to pick up each child promptly at GNC end time. Our policies do not allow Good News Club teachers or helpers to remain at school after club. Thank you
My child will be picked up at 5 pm from the park
My child has my permission to walk home.
Required
Please list any medical concerns, allergies or special considerations you would like us to know about your child. (or state 'None')
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Your answer
***By typing my full name below, I give my child listed above, permission to attend the Good News Club immediately after school at Solon Robinson City Park on
Apr 3, 17, and May 1, 15 and 29, 2024.
I also give permission for the people listed on this form to pick up my child. I understand it is my responsibility for my child to be picked up promptly at 5:00 pm and to contact Mary Beth Pawlowski if my child will not be attending.
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Your answer
Date
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MM
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DD
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YYYY
Additional Information:
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* This registration form is for Good News Club/Child Evangelism Fellowship use only.
I acknowledge that I have read this information
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