Glen Oaks Good News Permission
By filling out and submitting this form, you are giving your permission for your child to attend Glen Oaks Good News Club for the 2011-2012 school year. The form has space for registration of 2 children.
1st Child
First Name (*)
Required Information
Last Name (*)
Required field
Grade-Teacher (*)
Invalid Input
Allergies or Medical Conditions (*)
Required Info
2nd Child
First Name
Last Name
Grade/Teacher
Invalid Input
Allergies or Medical Conditions
Invalid Input
Address (*)
Required Input
Zip Code (*)
Invalid Input
Email Address (*)
Invalid Input
Contact Number (*)
Required Input
Emergency Contact Name (*)
Required Information
Emergency Contact Number (*)
Required Input
My child(ren) will go to Club 360. (*)
Please check one
My child(ren) may bike or walk home from GNC. (*)
Please check one
GNC has permission to photograph my child for non-advertising purposes. (*)
Please check one
The following people are authorized to pick up my child(ren) from Glen Oaks Good News Club:
Name(s)/Relation to child (*)
Please input the person(s) allowed to pickup your child(ren).