PIONEER CLUB 2017 REGISTRATION FORM
Welcome!
Please fill out the form below to register your child(ren) for Trinity Church's 2017-2018 PIONEER CLUB. Note: Fill out the entire form for your child. For each additional child, however, please fill out only the information that pertains to that child. Feel free to skip any information that remains the same.

Pioneer Club meets the first three Fridays of the month, October through April. Our first meeting this season is October 6, but your child is welcomed to join at any time throughout the year. Pioneer Club meets from 7:00 to 8:30 p.m.

The registration fee, covering books and supplies, is $35.

Child's Information
Child's Name (Last Name, First Name) *
Your answer
Child's Grade in September 2017 *
Allergies? *
Please list any allergies here *
Your answer
Parent/Guardian Information
Parent/Guardian Name (Last Name, First Name) *
Your answer
Home Address [complete](Street, City, State, Zip) *
Your answer
Email Address *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number *
Your answer
If we can't reach you, whom should we call? (Last Name, First Name) *
Your answer
What is their phone number? *
Your answer
Who, other than you, may pick up your child(ren)? *
Your answer
Media images and recordings help us tell the story of Pioneer Club to our church community. If you do not wish to have your child's photograph or image used in Trinity's print or web publications, please indicate below.
Comments
Do you have any comments or questions?
Your answer
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