Name of Pathfinder or Adventurer*

First

Last

Date of Birth

mm/dd/yyyy

School Year

Address*

Address 1

Address 2

City

Province/State

Postal Code

Country

PARENTS / GUARDIANS INFORMATION

Name of Parent(s) or Primary Guardian*

First

Last

Relationship to child*

Phone Number*

Email

Name Alternate Guardian

First

Last

Relationship to child

Phone Number

Email

MEDICAL INFORMATION

Please list all allergies - or type 'none' if there are none*

Does your child carry an epidural-pen (if yes, it is the responsibility of the parent/guardian to ensure the child has the epi-pen at every drop off and pick up)*

Yes

No

Please list all medical concerns (or type 'none' if there are none)*

Is there any additional information that we need to know about your child?

Photos and videos are taken for promotional purposes related to the Chesterfield Pathfinder & Adventurer Club. These may appear in Chesterfield SDA church's social media pages, the church's various websites. Do you allow your child to be included in these photo/videos?*

Yes

No

Seventh-day Adventist® Church

Chesterfield Seventh-day Adventist Church

Pathfinder & Adventurer Registration Form

Our Beliefs