5-Day Club Sign-Up

Club Host/Location *

CEF Local Chapter * 🛈

Participant Information

Child 1

Full Name *

Birth Date * +

Age *

Gender *

Male

Female

School

Grade

Child 2

Full Name

Birth Date +

Age

Gender

Male

Female

School

Grade

Child 3

Full Name

Birth Date +

Age

Gender

Male

Female

School

Grade

Child 4

Full Name

Birth Date +

Age

Gender

Male

Female

School

Grade

Child 5

Full Name

Birth Date +

Age

Gender

Male

Female

School

Grade

Household / Adult Primary Contact

Address 1 *

Address 2

City *

State *

Zip *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Phone *

Church (optional)

Emergency Contact Name (Full Name) *

Emergency Contact Phone *

Parent/Guardian Signature * 🛈

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Photo 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 for, but not limited to, advertising, educational, and promotional purposes.

Child 1 Name

Child 2 Name

Child 3 Name

Child 4 Name

Child 5 Name *

Parent/Guardian Signature for Photo and Video Release 🛈

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