College Church Catamounts Pathfinder Club Registration

Name of the person filling out this form*

First NameLast Name

Is the person filling out this form the LEGAL GUARDIAN of the child/children?*

DO NOT CONTINUE FILLING OUT THIS FORM! Only the legal guardian of the child/children is allowed to complete and submit this form.

How many children are you registering?*

Name (as they would like to be called)*

First NameLast Name

Gender*

Current Grade Level*

IMPORTANT: Young people who begin the Pathfinder year in grades 9-12 will be "transitional staff members." They will be assisting in Pathfinder Club activities, events and camping trips. Their involvement is encouraged, much needed, and greatly appreciated! Due to adult staff limitations, there will not be any separate highschool-focused club activities this year.

Please check this box if you agree:*

I understand that my third grader is welcome to attend Pathfinder meetings and activities, but cannot attend over-night campouts until after he/she has completed the third grade.

Name of School*

Where does this child attend church?*

Name of Church*

Birth Date*

MonthDayYear

T-Shirt Size*

List all allergies (including food and medications)*

Medical History (i.e. recent surgery, diabetes, chronic illness)*

List all current medications this child is taking*

Is there anything we should know about this child that might help us during activities? (i.e. paralyzing fears, ADHD, Asperger's syndrome, etc.)*

Name (as they would like to be called*

First NameLast Name

Gender*

Current Grade Level*

IMPORTANT: Young people who begin the Pathfinder year in grades 9-12 will be "transitional staff members." They will be assisting in Pathfinder Club activities, events and camping trips. Their involvement is encouraged, much needed, and greatly appreciated! Due to adult staff limitations, there will not be any separate highschool-focused club activities this year.

Please check this box if you agree:*

I understand that my third grader is welcome to attend Pathfinder meetings and activities, but cannot attend over-night campouts until after he/she has completed the third grade.

Name of School*

Where does this child attend church?*

Name of Church*

Birth Date*

MonthDayYear

T-Shirt Size*

List all allergies (including food and medications)*

Medical History (i.e. recent surgery, diabetes, chronic illness)*

List all current medications this child is taking*

Is there anything we should know about this child that might help us during activities? (i.e. paralyzing fears, ADHD, Asperger's syndrome, etc.)*

Name (as they would like to be called*

First NameLast Name

Gender*

Current Grade Level*

IMPORTANT: Young people who begin the Pathfinder year in grades 9-12 will be "transitional staff members." They will be assisting in Pathfinder Club activities, events and camping trips. Their involvement is encouraged, much needed, and greatly appreciated! Due to adult staff limitations, there will not be any separate highschool-focused club activities this year.

Please check this box if you agree:*

I understand that my third grader is welcome to attend Pathfinder meetings and activities, but cannot attend over-night campouts until after he/she has completed the third grade.

Name of School*

Where does this child attend church?*

Name of Church*

Birth Date*

MonthDayYear

T-Shirt Size*

List all allergies (including food and medications)*

Medical History (i.e. recent surgery, diabetes, chronic illness)*

List all current medications this child is taking*

Is there anything we should know about this child that might help us during activities? (i.e. paralyzing fears, ADHD, Asperger's syndrome, etc.)*

Name*

First NameLast Name

Mobile Phone Number*

Area CodePhone Number

Other Phone

Area CodePhone Number

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Where does this guardian attend church?*

Name of Church*

Is this legal guardian interested in helping the Pathfinder Club this year?*

Is there another individual who has LEGAL GUARDIANSHIP for the above child/children?*

Name*

First NameLast Name

Mobile Phone Number*

Area CodePhone Number

Other Phone Number

Area CodePhone Number

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Where does this guardian attend church?*

Name of Church*

Is this legal guardian interested in helping the Pathfinder Club this year?*

Physician's Name*

First NameLast Name

Physician's Phone*

Area CodePhone Number

Office Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name of legal guardian who has the medical insurance*

First NameLast Name

Medical Insurance Provider*

Provider Phone Number*

Area CodePhone Number

Policy Number*

Please check this box if you agree:*

I understand that the activities of this Pathfinder Club will be recorded using photography and/or video for use in College Church presentations, publications, websites, etc.

Please check this box if you agree:*

I am aware that my child/children may require emergency medical treatment as a result of accident or sickness; and in the event emergency medical treatment becomes necessary, I grant authority to the College Church Pathfinder Club to obtain such emergency medical treatment for my child/children listed above.

Please check this box if you agree:*

I indemnify and hold harmless the Atlantic Union, the Southern New England Conference, the College Church and its Pathfinder Club and staff from liability arising from any accident or injury occurring during club-sponsored functions. This does not waive coverage within the policy limits of church accident insurance, which covers church sponsored activities.

Signature of Legal Guardian (use your computer mouse or your finger if using a touch screen):

College Church Catamounts Pathfinder Club Registration

CHILD #1

CHILD #2

CHILD #3

LEGAL GUARDIAN #1

LEGAL GUARDIAN #2

FAMILY PHYSICIAN

MEDICAL INSURANCE

ACKNOWLEDGEMENTS