At which school would your child attend Good News Club?
Child's First Name and Last Name
Child's Grade in School
Child’s Age
Child's Birthdate
Gender
Parent's Name
Child's Home Address with City and Zip Code
Home Phone Number
Dad's Cell Phone
Mom's Cell Phone
Other Contact Person and Phone Number
Email address
Child's Food Allergies, if Applicable (peanuts, chocolate, etc.)
Where do you want your child to be dismissed?
For children dismissed directly from Club to pickup, who is authorized to pick up your child?
Church Your Family Attends
Check this box if you give permission to be included in Club photos for promotional purposes
