2022 Glyndale Elementary School Student Registration Form

Who: All boys and girls, grades 2nd-5th regardless of religious background

When: Thursdays beginning January 27, 2022

Time: 2:30pm- 4:00pm

Where: Glyndale Elementary School
1785 Old Jesup Rd, Brunswick, GA 31525

Parents are also welcome to attend with your child, however interaction with the other children are not allowed without a background check on file with Child Evangelism Fellowship.

Acknowledgements

My child (named below) is allowed to attend the Good News Club at Glyndale Elementary School every Thursday after school

Yes No

I understand that there will be no clubs on half days and school holidays.

Yes No

I understand that it is my responsibility to pick up my child at Glyndale Elementary School and failure to do so will jeopardize my child’s continued participation

Yes No

I understand CEF does not provide transportation to the Good News Club (GNC™) location. Parents must arrange transportation to the GNC location and must pick up each child promptly at GNC end time. Our policies do not allow GNC teachers or helpers to remain after club. If your child is not picked up immediately after club three times throughout the school year, he/she will not be allowed to continue attending.

Yes No

By signing via electronic signature method you are agreeing the electronic signature will be given full legal effect under federal and state law as if it were hand written. You are agreeing that you have read and understand the statements listed above.

Your Name

Child's Information

Please enter only one child per form.
Use Child's LEGAL Name, then add Nickname below.
Nickname should be what your child wants to be called at school.

Name

Nickname

Address

County

Brantley Camden Glynn Liberty Long McIntosh Out of Chapter

Birthdate

Gender Male Female

Grade

2nd 3rd 4th 5th

Homeroom Teacher

Additional Information

Please enter the BEST Phone Number and Email Address for correspondence with your child's Good News Club

Phone

This address will receive a confirmation email

Is either parent in the military?

Yes No

Church You/Your Family Attends

Special Instructions

Are there any security / custody issues with this child?

Yes No

Please explain security/custody issues:

Does your child have any special needs (ADD, Autism, Dyslexia, etc.)?

Yes No

Please explain special needs:

Does your child have any allergies (peanuts, chocolate, etc.)?

Yes No

Please explain allergies:

Any other information we should be aware of:

Pickup Person 1 Full Name

Pickup Person 1 Phone

Pickup Person 2 Full Name

Pickup Person 2 Phone

Contact Information

Please list IN ORDER those we will need to call in case of emergency.
Parents will always be called first.

Parent/Guardian 1 Full Name

Parent/Guardian 1 Phone

Parent/Guardian 2 Full Name

Parent/Guardian 2 Phone

Emergency Contact 1 Full Name

Emergency Contact 1 Relation to Child

Emergency Contact 1 Cell Phone

Emergency Contact 2 Full Name

Emergency Contact 2 Relation to Child

Emergency Contact 2 Cell Phone

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 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.

I approve the above Photography and Video Release

Yes No

If Yes, enter your name, or name of parent/guardian giving permission (if No, enter N/A)

COVID-19 Waiver

Dear Parent or Guardian:

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. As a result, federal, state, and local governments and agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

We are doing everything we can to be compliant with all regulations and ensure your safety. We have put in place preventative measures to reduce the spread of COVID-19, but we cannot guarantee that you or family members will not become infected with COVID-19.

By participating in programs, services, and activities of Child Evangelism Fellowship of Georgia® you agree to the following:

On behalf of yourself and your children, you hereby release, covenant not to sue, discharge, and hold harmless Child Evangelism Fellowship of Georgia, its employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any such program, service or activity.

Your Name

Today's Date

Description

Thursdays @ 2:30 pm after school beginning Jan 27 through end of March 2022

Good News Club® is a FREE, exciting, fun-filled weekly club for kids.
• Dynamic Bible Lessons
• Creative Learning Activities
• Inspiring Missionary Stories
• Meaningful, Fun Songs
• Life-Changing Scripture Memory

Your child will learn:
• Respect for Authority
• Moral Values
• Character Qualities
• Biblical Principles

Who teaches the club?
Specially trained Christians who are concerned for the spiritual well-being of your child teach the club.
All club workers are screened as required by CEF's Child Protection Policy to ensure your child’s safety.

Sponsored by: Child Evangelism Fellowship® of GA, Coastal GA

The United States Constitution requires schools to respect the right of all external organizations to distribute flyers to students at school if the school permits any such organization to distribute flyers. Accordingly, the school cannot discriminate among groups wishing to distribute flyers at school and does not endorse the content of any flyer distributed at school. The school encourages parents to assist their children in making choices appropriate for them.

This is not an activity of the school or the school district.

2022 Glyndale Elementary School Student Registration Form

Description

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