Good News Club Registration Form

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Good News Club Registration Form

Child's Name:

Birthday:

Age:

Address:

City:

State:

Zip:

School:

Grade:

Parent/Guardian:

Home Phone:

Dad’s Work Phone:

Mom’s Work Phone:

Emergency Contact Person:

Phone:

Emergency Contact Person:

Phone:

Child’s Allergies (peanuts, chocolate, etc.):

The following persons are allowed to pick up my child in the event that I cannot.

NAME

PHONE NUMBER

The above named child has my permission to attend the Good News Club program every week. I also give permission for the above named child's voice and image to be included in photos/videos for promotional purposes. I promise not to hold BMBC, its staff, or the host responsible for any injuries or sickness that has occurred at or as a result of this program.

Signature:

Date:

Download CEF Good News Club Registration Form 2024