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Child Information

Name: {field:firstname_ci} {field:lastname_ci}

Date of Birth: {field:date_of_birth_ci}

Age: {field:age_ci}

My child can have a snack during CM Activities: {field:my_child_can_have_a_snack_during_cm_activities_ci}

Does your child have any food allergies? {field:does_your_child_have_any_food_allergies_ci}

List all allergies your child has. {field:list_all_allergies_your_child_has_ci}

Parent/Guardian 1 Information

Name: {field:firstname_pg1} {field:lastname_pg1}

Phone#: {field:phone_pg1}

Email: {field:email_pg1}

Address: {field:address_pg1} {field:city_pg1} {field:statelist_pg1}, {field:zip_pg1}

Parent/Guardian 2 Information

Name: {field:firstname_pg2} {field:lastname_pg2}

Phone#: {field:phone_pg2}

Email: {field:email_pg2}

Address: {field:address_pg2} {field:city_pg2} {field:statelist_pg2}, {field:zip_pg2}

Pickup Contact 1

Name: {field:firstname_pc1} {field:lastname_pc1}

Email: {field:email_pc1}

Phone#: {field:phone_pc1}

Relation to child: {field:relation_to_child_pc1}

Pickup Contact 2

Name: {field:firstname_pc2} {field:lastname_pc2}

Email: {field:email_pc2}

Phone#: {field:phone_pc2}

Relation to child: {field:relation_to_child_pc2}

Emergency Contact

Name: {field:firstname_ec} {field:lastname_ec}

Phone#: {field:phone_ec}

Email: {field:email_ec}

Relation to child: {field:relation_to_child_ec}

Address: {field:address_ec} {field:city_ec} {field:statelist_ec}, {field:zip_ec}

Activities

Sabbath School: {field:sabbath_school_selection_activity}

My child will sign up for the Adventurer's Club: {field:my_child_will_sign_up_for_the_adventurer_s_club_activity}

My child will join Crazy Praize: {field:my_child_will_join_crazy_praize_activity}

Does your child play an instrument? {field:does_your_child_play_an_instrument_activity}

List of instruments my child plays: {field:list_of_instruments_my_child_plays_activity}

Children's Story/Church: {field:children_s_story_church_activity}

In what areas would you like to volunteer? {field:in_what_areas_would_you_like_to_volunteer_activity}

Adventurer Club Registration

Child's First Name: {field:child_s_first_name_acr}

Child's Last Name: {field:child_s_last_name_acr}

Child's DOB: {field:birth_date_acr}

Grade: {field:select_grade_acr}

Parent's First Name: {field:parent_s_firstname_acr}

Parent's Last Name: {field:parent_s_lastname_acr}

Address: {field:address_acr} {field:city_acr} {field:statelist_acr}, {field:zip_acr}

Cell Phone: {field:cell_phone_acr}

Emergency Phone: {field:emergency_phone_acr}

Email: {field:email_acr}

Home Phone: {field:home_phone_acr}

Church: {field:church_acr}

School: {field:school_acr}

Select the class/classes you have been invested in: {field:select_the_class_classes_you_have_been_invested_in_acr}

I {field:i_person_name_acr} want to join the {field:want_to_join_the_acr} Adventurer Club. I will attend meetings, activities, field trips, and other club activities. I will proudly wear my Adventurer uniform and obey club guidelines. I will abide by the Adventurer pledge and law.

Pledge:
Because Jesus Loves Me, I will always do my best.

Law:
Jesus can help me to: Be obedient, Be pure, Be true, Be kind, Be respectful, Be attentive, Be helpful, Be cheerful, Be thoughtful, Be reverent.

{field:signature_of_adventurer_acr}

Signature of Adventurer

{field:consent_of_parent_guardian_1609456204672}

{field:signature_of_parent_guardian_acr} {field:sig_date_acr}
Signature of Parent/Guardian

Club Health Record and Insurance Information

Adventurer's First Name: {field:adventurer_s_first_name_chraii}

Adventurer's Last Name: {field:adventurer_s_last_name_chraii}

Allergies to food/drugs: {field:allergies_to_foods_drugs_chraii}

Any special medications or pertinent information: {field:any_special_medications_or_pertinent_information_chraii}

Date of last Tetanus booster: {field:date_of_last_tetanus_booster_chraii}

Activity restrictions: {field:activity_restrictions_chraii}

Family Physician Information

First Name: {field:physician_firstname_chraii}

Last Name: {field:physician_lastname_chraii}

Address: {field:physician_address_chraii} {field:physician_city_chraii} {field:physician_statelist_chraii}, {field:physician_zip_chraii}

Business Phone: {field:physician_business_phone_chraii}

The above named minor is not covered by health insurance: {field:the_above_named_minor_is_not_covered_by_health_insurance_chraii}

Insurance Provider: {field:insurance_provider_chraii}

Policy #: {field:policy_number_chraii}

Emergency Authorization Statement to Treat a Minor

I (we) the undersigned parent, or legal guardian of {field:i_we_the_undersigned_parent_or_legal_guardian_of_chraii} {field:emergency_authorization_statement_body_1_1609460183264} {field:church_name_chraii} {field:emergency_authorization_statement_body_2_1609460495584}

{field:signature_of_parent_guardian_chraii} {field:signature_of_parent_guardian_date_chraii}