Good News Clubs – James River

Registration for James River Good News Club

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If you continue to have difficulties, call or email the club representative listed below. Thank you!

When: 3:30pm – 4:45pm
Where: Every Thursday starting February 1st to April 25th at James River Elementary School – Music Room
Who: All boys and girls in grades K5 – 5, regardless of religious background. Parents are welcome to attend with their child.
Contact: Helen Holbrook, holbrookhelen@gmail.com
Sponsored by: Williamsburg Community Church & CEF of VA-Peninsula

Good News Clubs - James River Elementary

Child's Name *

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

Age *

Gender *

Male

Female

School *

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

Homeroom Teacher *

Child's Allergies *

Yes

No

Child's Allergies (ie. chocolate, etc.)

Parent in the military? *

Yes

No

Do you attend a church?

Yes

No

Name of church attending

Parent or Guardian

Email

Home phone

Dad's name *

Dad's cell phone *

Email *

Mom's name *

Mom's cell phone *

Email *

Addess *

Addess

Addess

Addess

City

City

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State

Zip Code

Zip Code

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.

Parent /Guardian: Your child must be picked up immediately after the club ends. Our policies do not allow Good News Club teachers or helpers to remain at school after club. Thank you.

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

Name *

Relation *

Phone *

Name

Relation

Phone

I authorize for my child to attend the Good News Club after school during the 2023-24 school months. *

Yes

I understand it is my responsibility to pick up my child at 4:45pm, and that there will be no club on half-days nor on school holidays. *

Yes

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

Yes

I authorize my child to be photographed for use in club and ministry promotions.

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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