Pioneer Clubs Signup Form

Form to enroll in Pioneer Clubs at Shoreline Covenant Church
Family Information
The child's parent(s) or guardian
Your family's main contact number
A number such as a cell where you can be reached during Pioneer Club
Name of the church your child regularly attends, if any
Who else should we contact if parent(s) or guardian can't be reached
Relationship of other emergency contact to child
Phone number of other emergency contact
Child One
Information for the first child you are registering
Grade level child will enter in the fall
school your child attends or indicate if homeschooled
Select Club Level
Enter any food allergies or other medical issues we should know concerning this child
Child Two
Enter information for the second child from your family that you want to enroll
Grade level child will enter in the fall
school your child attends or indicate if homeschooled
Select Club Level
Enter any food allergies or other medical issues we should know concerning this child
Child Three
Enter information for the third child from your family that you want to enroll
Grade level child will enter in the fall
school your child attends or indicate if homeschooled
Select Club Level
Enter any food allergies or other medical issues we should know concerning this child
Child Four
Enter information for the forth child from your family that you want to enroll
Grade level child will enter in the fall
school your child attends or indicate if homeschooled
Select Club Level
Enter any food allergies or other medical issues we should know concerning this child
Approval
I hereby give approval for my child to participate in Pioneer Clubs at Shoreline Covenant Church. I release Shoreline Covenant Church and Pioneer Club leaders and assistants from all liabilities pertaining to these activities. I authorize emergency medical care when deemed necessary.
Photo Approval
I authorize SCC to use photos of my child for ministry purposes. I understand these photos may appear on bulletin boards or slide shows at SCC or on the SCC website.
If you do not want your child's photos used, please note above
Enter the name of the parent approving this application
Please add any additional information you would like the Registrar to know
Parent Information
Thank you for your registration form for Pioneer Clubs at Shoreline Covenant Church. Our first meeting is Wednesday Sept 21, 2016, 6:30-8:00pm. Registration Fees will be collected at the first Pioneer Club meeting (and club meetings thereafter). There is a suggested donation of $15 for 1 child or $25 for a family. SCC accepts cash or checks payable to Shoreline Covenant Church (note Pioneer Club Registration in the memo line). Registration covers club supplies such as awards, special events, memory store prizes, and tote bags. We encourage students to keep their bags from year to year. Contact Jen Fisker-Andersen (jenjohnfa@gmail.com) directly if there are any questions. PRINT THIS PAGE FOR YOUR RECORDS