2023-2024 Pomerene Good News Club Parent/Guardian Permission/Registration Form

Please fill out this form and click submit.

Every Thursday, Starting 9/21/23; 2:30-4:00 pm at New Life Family Worship Center (across the street from Pomerene School)

Child's Name

Birthdate

Grade

Please select one option.

Kindergarten 1st 2nd 3rd 4th 5th 6th

Parent/Guardian's Name

Phone

Address

After Club:

Please select one option.

I will pick up my child My child has permission to walk/bike home

Emergency Contact Name

Emergency Contact Phone

Other Adults Authorized To Pick Up My Child:

Health Concerns/Known Allergies Of My Child:

Photo Release Permission

Please select all that apply.

I do not give permission for my child to be photographed. I give permission for my child to be photographed.

Sierra Vista Unified School District neither endorses nor sponsors the organization or activity represented on this form. The distribution of this form or material associated with it is provided as a community service.

Assumption of Risk Waiver

By typing my FULL NAME into this field I certify/affirm that: 1) I am the parent/legal guardian of the child on this form. 2) I give my child permission to attend Good News Club. 3) I am responsible for my child from the time he/she leaves the school grounds until he/she reaches home.

(GOOD NEWS CLUB ADMINISTRATIVE USE ONLY) Club Administrators - Type your full name in this field to 1) Indicate you are registering a student from a paper form and 2) You have verified the paper form contains a parent/guardian's signature.

Description

Please fill out this form and click submit.

2023-2024 Pomerene Good News Club Parent/Guardian Permission/Registration Form

Description

Please Fix the Following