HEAVEN'S TRAIL ADVENTURER CLUB
REGISTRATION FORM FOR 2021-2022 COLLEGE PARK CHURCH, OSHAWA
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WE ARE ADVENTURERS.....
Child Name First and last *
Date of Birth *
(if on PC click on calendar, if on phone type the numbers in the field )
MM
/
DD
/
YYYY
Grade in September 2021 *
Parent(s)/Caregiver(s) Name(s) *
Home Address
Phone Number (during Adventurer classes) *
Secondary or Emergency Contact Phone Number *
Name and Relationship to child (Secondary or Emergency contact) *
Email *
ALL COMMUNICATIONS WILL BE SENT VIA EMAIL (please enter only one email address)
Secondary Email
if applicable (please enter only one email address)
Home Church (please type "NONE" if you don't have one) *
School *
Child pledge *
Required
Signed by child joining
Will your child be participating in ABE?
Clear selection
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:
Required
Signed by Parent(s)/Caregiver(s) of child joining *
Required
AUTHORIZATION TO TREAT A MINOR: *
In case of an emergency, as parent(s) / legal guardian(s) of
I/We give permission to the physician selected by the Club directors to hospitalize or secure proper treatment for my child. *
Required
Signed by Parent(s)/Caregiver(s) of child joining *
Required
Child’s allergies, other medical conditions, medication currently taking: (if no allergies known type "NONE") *
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