Jackson Chapter’s JYC Registration

Learn how much God loves you, how valuable you and all people are, how God can help you do the right thing, have peace in hard times, and care for others. You will be taught truths from the Bible through exciting lessons, songs, prayer, games and treats!

Info for Parent/Guardian:

• At club time, members are released into the care of Child Evangelism Fellowship® (CEF®) staff volunteers from various Bible believing Church congregations who care about the well-being of your child(ren). Each has been trained and screened with criminal records checks in accordance with CEF policy.
• Each class is supervised by at least two staff during meetings and if they walk or are bussed to the meeting place off-campus nearby.
• Junior Youth Challenge (JYC^™) Jesus Pizza Club is provided for children from all backgrounds (including homeschool) who do not require extra or specially-trained staffing.
• Laws support your right to be informed of and have the choice of this public education 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 at school. The school encourages parents to assist their children in making choices appropriate for them.
• JYC^™ Jesus Pizza Clubs are not an activity of the school or the school district, but are funded and staffed by CEF, a mission of the Church.
• JYC^™ Jesus Pizza Club will be held during lunch time. No class work will be missed.
• Any person or child with any symptoms of any illness should not come.
• Weekly clubs generally run from October to April. Registered families will be contacted for exact dates or if there are any changes.
• Please leave an active email address when registering your child(ren). This will be one way your club coordinator will communicate with you regarding the club you register for.
• For more info, call CEF Jackson at 541-500-8880 ext. 1 or contact us online.

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—Abraham LincolnOak GrovePhoenixButte FallsShady CoveSams Valley

Student First Name *

Student Last Name *

Age *

Birth Date *

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

Club Date photos

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