Maywood Memorial School | North Jersey Chapter

Club Information
This registration is for the Good News Club for Memorial Avenue School students at the Maywood Public Library hosted by Child Evangelism Fellowship of North Jersey.

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

Club will meet every Tuesday afternoon immediately after school until 4:15 PM, except for school holidays. We will meet in the Maywood Public Library, 459 Maywood Ave.

Club begins Tuesday, October 15, 2024, and will end on May 13, 2025.

Parent/Guardian Signature *

By typing your name, you consent to signing this document electronically.

Date *

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

My child will be picked up after Good News Club.

My child will walk home after Good News Club.

My child is registered for and will attend the extended day/after-school program at Memorial Ave. School.

If extended day/after-school program was selected above, insert Name of Program.

Child's First Name *

Child's Last Name *

School *

Homeroom Teacher *

Grade *

Male / Female *

Male

Female

Birth Date *

Age *

Street Address *

Apt #

City *

State *

Zip Code *

List any security/custody issue with this child.

List any special needs (ADD, Asperger's, Dyslexia, etc.)

Child's allergies (peanuts, chocolate, etc.)

Email Address *

Dad's work/cell phone

Home Phone *

Mom's work/cell phone

Church

Is either parent in the military?

Yes

No

Emergency Contact 1 *

Emergency Contact 2

Emergency Contact 1 Phone Number *

Emergency Contact 2 Phone Number

In addition to those listed above, the following people are allowed to pick up my child:

Name 1

Name 2

Phone Number 1

Phone Number 2

Parent/Guardian Signature *

By typing your name, you consent to signing this document electronically.

Date *

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.

Parent/Guardian Signature

By typing your name, you consent to signing this document electronically.

Date