Good News Club Registration

Note: Fields highlighted pink are required!

Club Information

Club: Ebb Valley
2025 - 2026
Day of WeekStart TimeEnd Time
Thursday16:1017:30
Team Lead(s)Phone #Email
Jewel Czaja443-824-0424jewelczaja@gmail.com
Please contact the team lead directly for any questions, concerns, or registration issues.

Primary Parent/Guardian

First Name
Last Name
Parent/Guardian Type
Phone #
Email
Preferred Contact Method
Address

Child Information

Addition Parent(s)/Guardian(s)

Security or Custodial Issues
No security issues

Final Details

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

Signature