Good News Club Registration

Note: Fields highlighted pink are required!

Club Information

Club: Eldersburg
Day of Week Start Time End Time
Monday 2:30 pm 4:00 pm
Team Lead(s) Phone # Email
Darlene Ely 443-547-2646 dely216@comcast.net
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