Jackson Chapter’s JYC Registration

Join us for a FREE lunch, Bible Study & Prayer!

Info for Parent/Guardian:

• JPC is designed to help meet the spiritual needs of middle school students with an interactive Bible study and prayer. Developing good character is emphasized to help students succeed and the school and needs of students are prayed for.
• Students meet a team of two or more club staff workers at the school office at the start of lunch and walked off campus to the club location. They are brought back to the school office at the end of the lunch period. 
• Lunch is provided free of charge. Food donations are welcome, and members can bring sack lunches if they prefer or have specific allergies/food needs. 
• JPC is staffed by a team of caring volunteers from various local Church congregations who are trained and screened with criminal records checks. 
• JPC is a middle school ministry of CEF, a mission of the Church that has been conducting Good News Clubs for local public elementary school students for over 60 years.
• Laws support your right to be informed of and have the choice of this public educational option. The US Constitution requires schools to respect the right of all external organizations to distribute flyers to students at school if the school permits any such organization to distribute flyers. Accordingly, the school cannot discriminate among groups wishing to distribute flyers at school and does not endorse the content of any flyer distributed, the school encourages parents to assist their children in making choices appropriate for them.
• GNCs/JYCs are not an activity of the school or the school district, but are funded and staffed by CEF, a mission of the Church.
• A person or child with any symptoms of illness should not come. This includes any in the household or family.
• By attending CEF Jackson’s Jesus Pizza Lunch Club, you agree to abide by the procedures established by CEF to protect attendees and staff/volunteers.
• For more info, call the CEF Jackson office at 541-500-8880, or email us at secretary@cefjackson.org

JYC Club Registration

Please fill out a separate form for EACH child attending and Click “submit” when finished.

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Club *—Select School—Oakdale Middle School

Student First Name *

Student Last Name *

Age *

Birth Date *

Phone you First

Gender *

• F
• M

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Email *

Email

Confirm Email

Food Allergies *

Church

Special Needs

Authorized Pick-up Alternate

Authorized Pick-up Alternate Phone

After club child will *—Select—Be picked upWalk homeGo to an after-school program

Grade *

Teacher *

Room Number *

Check if you do not wish to have your child in club photos

• Do not include child in club photos

I give permission to release this child into the care of the JYC staff each week. I will notify the CEF office if I no longer want my child to attend. I will pick up my child at club location at end of club time. I will not let my child attend if they show any symptoms of illness. CEF/Host are not responsible for anyone contracting any illness. By signing this I agree that my child will obey club rules and staff and will not require special behavioral accommodations.

Parent/Guardian Signature

Clear Signature

Date

Signer's Realtion to Child

Additional Notes

Submit