Locust Grove After School In School Good News Club

Please complete and submit a registration form for each child

Registration Form

Child's Name

Child's Birthday

Child's Gender Child's Gender Male Female

Child's Grade

Child's Teacher

Child's Address

Church Affiliation

Child's Allergies

Contact Person

Relationship to Child

Contact 1 Phone

Contact 1 Email

Additional Contact Person

Additional Contact Phone

Additional Contact Email

Name of the person (other than the parent) allowed to pick up my child after Good News Club

Please read and agree to the Permission Statement Please read and agree to the Permission Statement Yes, I agree to the Permission Statement No, I do not agree to the Permission Statement

I certify that I am the parent/guardian of the above-named child. I certify that I am the parent/guardian of the above-named child. Yes, I am the Parent/Guardian No, I am not the Parent/Guardian

Please type your full name as your virtual signature to all of the above:

10 + 7 =

MEETS: TUESDAYS 3:30 P.M. to 4:55 P.M. AFTER SCHOOL at Grace Baptist Church
3920 East Prospect Road
Class in process (children may join any week) Club will run from Oct. 14, 2025 to Apr. 21, 2026
Parents are responsible for transportation home. CEF cannot provide transportation home.
CHILDREN MUST BE PICKED UP BY 5:00 P.M.
SPONSORED BY: Child Evangelism Fellowship of York County.
For more information contact Lisa Garlick, Director at (717) 757-3212 or lisagarlick@cefepa.net

Permission Agreement

I give permission for my child to take part in the After School Good News Club Program. In case of a medical emergency I give permission to the physician selected by the CEF of York County to secure proper treatment. In extreme emergency circumstances they may hospitalize, order medication and, if necessary, surgery. I agree that my child is in good physical condition and able to participate in the After School/Good News Club program they are registering for. I agree to hold Grace Baptist Church and CEF of York County, Inc. harmless, and to secure them against all losses and expenses due to injury or alleged injury to my child in relation to their participation in this program. I also assume the responsibility of any damages to the facility and/or equipment being used caused by him or her. I grant permission for any photos taken of my child to be used for future publications.