Registration – CEF Carroll County

Good News Club Registration

Note: Fields highlighted pink are required!

Club Information

Club: Piney Ridge

Day of Week	Start Time	End Time
Monday	3:30 pm	5:00 pm

Team Lead(s)	Phone #	Email
Darlene Ely	443-547-2646	dely216@comcast.net
Sara Tully	443-983-3430	sarakmtully@gmail.com

Please contact the team lead directly for any questions, concerns, or registration issues.

Child Information

Parent/Guardian #1

First Name

Last Name

Phone #

Email

Address

Parent/Guardian #2

First Name

Last Name

Phone #

Email

Address

Additional Contacts - Pickup or Emergency

Final Details

Church Affiliation

Note - we will try to accomodate your childs needs, but we are not equipped to handle all situations.

Signature

Name	Responsibilities	Phone
	Pick up after club Emergency Contact

CEF Carroll County

CEF® is a Bible-centered, interdenominational, worldwide organization, composed of born-again believers whose purpose and mission are to evangelize boys and girls with the Gospel of the Lord Jesus Christ, disciple them in the Word of God, and establish them in a Bible-believing church for Christian living.