Times Available (Please make a selection)
Calaveras Unified School Distric (Valle Springs), Valley Springs Elementary: Tuesdays 2:15-3:15pm
First Name
Last Name
Grade
Birthdate
Gender
First Name
Last Name
Grade
Birthdate
Gender
First Name
Last Name
Grade
Birthdate
Gender
is allowed to attend the Good News Club every week after school until the Club concludes – see list for dismissal time. (There will be no clubs on school holidays.) I understand it is my responsibility to pick up my child immediately after the club, and failure to do so will jeopardize my child’s continued participation.
Name of School
Child's Grade & Homeroom Teacher
School District
Family Email
Family Phone Number
Family Address (Physical address for mailing items to the children)
List any security/custody issues with this child?
List any special needs (ADD, Asperger’s, Dyslexia, etc.)
Child’s Allergies(peanuts, chocolate, etc)
Emergency Contact
Digital Signature
For your child’s safety, only children with permission from parents may attend. Also, teachers in our clubs have been screened according to the Child Protection Policy of Child Evangelism Fellowship.
OPTIONAL Photography and Video Release (Not required for club attendance)
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.
Permission of Photography Digital Signature
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