PIONEER CLUB 2018 REGISTRATION FORM
We are excited for a new year of Pioneer Club and hope you are too!

Please fill out the form below to register your child(ren) for Trinity Church's 2018-2019 PIONEER CLUB.

Pioneer Club meets the first three Fridays of the month, October through April. Our first meeting this season is October 5, 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. (Checks should be made out to Trinity Church.)

Parent/Guardian Information
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Email Address *
Your answer
Home Address (Street) *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
If we can't reach you, whom should we call? (name and phone number) *
Your answer
Adult(s), other than you, who may pick up your child *
Your answer
First Child's Information
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Age *
Your answer
Child's Grade in September 2018 *
Allergies? *
Please list any allergies or special needs here (If no allergies, write "none") *
Your answer
Second Child's Information
Second Child's Last Name
Your answer
Second Child's First Name
Your answer
Second Child's Age
Your answer
Second Child's Grade in September 2018
Allergies?
Please list any allergies or special needs here
Your answer
Third Child's Information
Third Child's Last Name
Your answer
Third Child's First Name
Your answer
Third Child's Age
Your answer
Third Child's Grade in September 2018
Allergies?
Please list any allergies or special needs here
Your answer
Fourth Child's Information
Fourth Child's Last Name
Your answer
Fourth Child's First Name
Your answer
Fourth Child's Age
Your answer
Fourth Child's Grade in September 2018
Allergies?
Please list any allergies or special needs here
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.
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