EmailMe Form - CPC Adventurers Registration

Name *

First Last

Date of Birth *

MM / DD / YY

Grade: *

Parent(s) / Guardian Information

Please enter parent or legal guardian information here

Name *

First Last

Phone *

### - ### - ####

Email *

Address: (if different from last year)

Street Address City State / Province / Region Postal / Zip Code

Home Church:

School:

Emergency Contact:

Name *

First Last

Phone *

### - ### - ####

Relationship to child:

Child's Pledge *

I want to join the Heaven’s Trail Club.

I will attend Club meetings, activities, field trips and other Club events.

I will proudly wear the Club uniforms, and be obedient, pure, true, kind, respectful, attentive, helpful, cheerful, thoughtful and reverent.

Please check all boxes

Signed by child joining *

I accept the guidelines and confirm that all the above information is correct.

PARENT/GUARDIAN APPROVAL/CONSENT

As parent(s) / guardian(s), I /We understand that the Club is a family program that includes many opportunities for service, adventure, fun and learning. I will support the program by: *

1. Encouraging my child to take an active part in all club meetings and functions and will do my best to arrive on time at all times.

2. Attending events in support of my child.

3. Assisting club instructors by serving as a helper when needed.

4. Not holding any individual Club staff member liable in the event of an accidental injury.

5. Giving permission for the above named child to attend Club activities.

6. Giving permission for the above named child to be photographed/videotaped during club activities and consent to the release of his/her image and name appearing for Club activities and advertisement purposes in print and online.

Please check all boxes

Signed by child joining *

I accept the guidelines and confirm that all the above information is correct.

AUTHORIZATION TO TREAT A MINOR:

In case of an emergency, as parent(s) / legal guardian(s) of *

Child's Name

I/We give permission to the physician selected by the Club directors to hospitalize or secure proper treatment for my child.

Child’s allergies, other medical conditions, medication currently taking: *

Signed by child joining *

I accept the guidelines and confirm that all the above information is correct.