Hixson Middle School | JYC Registration Form | 2024-2025

Who can attend? All middle schoolers, regardless of religious background. Parents are welcome to attend with their child; however, interaction with other children is not allowed without a background check on file with CEF.

Please complete one form per child.

Acknowledgements

My child (named below) is allowed to attend the Jesus and You Connection (JYC) Club at Hixson Middle School.

Yes No

I understand that there will be no clubs on half days and school holidays. Clubs will run concurrent with the school calendar.

Yes No

I understand CEF does not provide transportation to the JYC Club location. Parents must arrange transportation to the JYC location and must pick up each child promptly at JYC end time. Our policies do not allow JYC teachers or helpers to remain after club. If your child is not picked up immediately after club three times throughout the school year, he/she will not be allowed to continue attending.

Yes No

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form. You are agreeing that you have read and understand the statements listed above.

Your name

Child's Information

Child's legal name

Nickname

Homeroom teacher

Grade

Gender

Male Female

Birthdate

Address

List any security/custody issues with this child

List any special needs we should be aware of (ADD, Asperger's, Dyslexia, etc.)

Child's allergies (peanuts, chocolate, etc.)

How will your child get home on club day?

Church your family attends

Contact Information

Please enter the BEST mobile number to reach someone.

Phone

Please enter the BEST email address for correspondence with your child's JYC Club.

This address will receive a confirmation email

Parent/guardian 1 name (relation to child)

Parent/guardian 1 phone

Parent/guardian 2 name (relation to child)

Parent/guardian 2 phone

Emergency contact 1-other than parent/guardian (relation to child)

Emergency contact 1 phone

Emergency contact 2-other than parent/guardian (relation to child)

Emergency contact 2 phone

Permission for Pick Up

In addition to those listed above, the following people are allowed to pick up my child:

Additional pick up person 1 (relation to child)

Additional pick up person 1 phone

Additional pick up person 2 (relation to child)

Additional pick up person 2 phone

Photography and Video Release

Child Evangelism Fellowship® may, from time to time, document the activities of the ministry with photos or videos. I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership, use and proceeds of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for, but not limited to, advertising, educational and promotional purposes.

I approve the above photography and video release.

Yes No

Child's name

If yes, name of parent giving permission (if no, enter N/A)

Description

TBD

Hosted and conducted by: Pilgrim's Rest Baptist Church
Contact: Danny Ledford (Email: dledford113@gmail.com)
Sponsored by: Child Evangelism Fellowship® of TN, Greater Chattanooga Chapter

Jesus and You Connection (JYC) is an exciting, fun-filled weekly club for pre-teens and teens.
• Dynamic Bible Lessons
• Creative Learning Activities
• Inspiring Missionary Stories
• Meaningful, Fun Songs
• Life-Changing Scripture Memory

Your child will learn:
• Respect for Authority
• Moral Values
• Character Qualities
• Biblical Principles

Who teaches the club?
Specially trained Christians who are concerned for the spiritual well-being of your child teach the club.
All club workers are screened as required by CEF's Child Protection Policy to ensure your child’s safety.

The United States 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.

This is not an activity of the school or the school district.

Hixson Middle School | JYC Registration Form | 2024-2025

Description

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