Good News Clubs – Coventry

Registration for Coventry Good News Club

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Good News Clubs - Coventry

Good News Club
Time: 3:20pm- 5:00pm
Date: Monday, October 3rd through Novemeber 14th 2022.
Place: Coventry Elementary School - Room 401
Who can attend? All boys and girls ages 5-12, regardless of religious background. Parents are welcome to attend with their child.
Sponsored by: Child Evangelism Fellowship (CEF) of VA Peninsula
Contact: 757-291-2091; Dianne Tate; dianne.tate77@gmail.com

Child Name *

Birthday - (e.g.; 10/23/2018) *

Age *

Gender *

Male

Female

Grade Level (K, 1, 2, 3, 4, 5) *

Homeroom Teacher *

Child Allergies *

Yes

No

If yes, please list allergies (peanuts, chocolate, etc.)

Is parent in military? *

Yes

No

Does your child attend church?

Yes

No

Name of church attending

Parent/Guardian Name #1 *

Parent/Guardian Phone #1 *

Parent/Guardian Email #1 *

Parent/Guardian Name #2 *

Parent/Guardian Phone #2 *

Parent/Guardian Email #2 *

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Select how your child will get home on club day. *

My child will be picked up

My child will transition to the school’s extended day/after-school program.

These people (include phone numbers) are allowed to pick up my child if I’m not able to:

Name *

Phone Number *

Name

Phone Number

I give my permission for my above-named child to attend the Good News Club during the 2022-23 school months. *

Yes

I understand it is my responsibility to pick up my child immediately when the club ends. *

Yes

I will send a note to the school requesting my child stay after school to attend the Good News Club. *

Yes

I give permission to enroll my child in age-appropriate, free Bible lesson course by mail: Mail Box Club (stamp cost only)

Yes

I give permission for photographs/videos of my child to be used in club and ministry promotions.

Yes

Contact me about helping with the Good News Club

Yes

Parent/Guardian Signature: Enter your signature in the box using your finger on the touch-pad/track-pad or with your mouse's cursor in the box. *

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Date

Reference Number

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