2016-2017 Kirkland Kernels Adventurer Club Membership Application
Registration and fees are $50/year per child--scholarship is available.
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Applicant Information
Name of Child *
Grade *
Email *
Please provide an address you check frequently.  This is used as our main communication about meetings and events.  Include both parents' email addresses if both want to receive updates.
Primary Phone *
Child's Birthday *
MM/DD/YYYY
Age *
Mother's / Guardian's Name *
Mother's / Guardian Cell Phone
Father's / Guardian's Name *
Father's / Guardian's Cell Phone
Emergency Contact & Phone *
Specify relationship
Alternate Emergency Contact & Phone
Specify relationship
Home Address *
Street, City, State, Zip
School
Sibling's Name and Age
Denomination and Church
If applicable, where else has the applicant been a(n) Little Lamb / Eager Beaver / Adventurer?
Stars, Chips or Awards earned over summer, if any
Check class(es) invested:
Swimming Level
Date of Baptism (if applicable)
MM/DD/YYYY
Has parent/guardian been a(n) Little Lamb / Eager Beaver / Adventurer before?
Medical Information
Date of Last Tetanus Booster
Conditions that may cause Emergencies
Allergies, asthma, diabetes, fainting, epilepsy, others (include food allergies or restrictions applicant may have)
Medications
Prescription and over the counter drugs and what it is for
Conditions that may limit participation in Meetings, Physical Activities or Campouts
Health problems, accidents, illnesses, operations, others
Other Pertintent Information
Insurance Information
Insurance Provider
Policy #
Name on Policy
Primary Care Physician
Physican's Clinic/Hospital & Address
Physician's Phone
Additional Comments or Suggestions
Adventurer Pledge
Because Jesus loves me, I will always do my best.
Adventurer Law
Jesus can help me to
• Be obedient
• Be pure
• Be true
• Be kind
• Be respectful
• Be attentive
• Be helpful
• Be cheerful
• Be thoughtful
• Be reverent
Kirkland Kernels Adventurer Club Merit System
The Kirkland Kernels Adventurer Club uses a merit system.  Each member is responsible for his or her own behavior and actions.  With parental help, the member is responsible for being aware of his or her standing and discussing any disagreements or discrepancies with the counselor.  Those that earn 90% of possible merit points will qualify for a reward at the end of the year.

Point System:

Ten points are available for every regular club meeting and event.  The points are broken down as follows:

1 - Attendance
1 - Arriving on time at fall in
2 - Complete uniform, neatness of appearance
3 - Obedience/orderly conduct (silent when at attention, assignment turned in on time, following instructions, etc)
3 - Spirit/participation

The points available each month will vary depending on the number of scheduled club activities.

Family Campout:
The annual conference sponsored Adventurer Family Campout at Sunset Lake Camp is an event open to members and non-members of an Adventurer Club.  This is an optional event for the KKAC members and no merit points are earned.

Community Service:
Praise Time and other club community services are optional meetings and members can earn up to 8 extra merits.   An additional 8 extra points may be earned at the discretion of the directors and should be turned into the counselor by April 25, 2017 for consideration.

Spring Picnic:
This fun event is exclusively for members and family only.  No merits are given for this optional event.

Absences and Tardiness:
Illness, family emergency, travel, required school trips, or other staff approved absences are excused.  Each member may have two excused absences per year in cases of large amounts homework given on Wednesday night.  Parents need to provide written notification to the counselor for ALL excused absences.
Applicant's Agreement
I would like to join the The Kirkland Kernels Adventurer Club. I will attend meetings, activities, field trips, and other club activities. I agree to be guided by the Adventurer Pledge and Law and the Kirkland Kernels Adventurer Club Merit System .  I will be cheerful, helpful, honest, kind and courteous.
Applicant's signature *
Printed name is signature
Date *
Consent of Parents or Guardians
The applicant is at least 4 years old (by 1/1/17) or has prior approval of club leadership.

In case of emergency, we hereby give permission to the physician selected by the club directors to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child.

We have read the Kirkland Kernels Adventurer Club Merit System and the Adventurer Pledge and Law and desire that the applicant join the Kirkland Kernels Adventurer Club (KKAC). We will assist the applicant in observing the rules of the KKAC.

As parents, we understand that the Little Lamb/Eager Beaver/Adventurer program is an active program and that for our child to receive the most benefit, he/she needs to attend as many of the meetings and events as possible (there are typically three Wednesday night meetings each month). The program includes many opportunities for service, adventure, fun and learning. We will cooperate by:

1. Learning how we can assist the applicant and his/her leaders.
2. Encouraging the applicant to take an active part in all meetings and activities.
3. Attending events and meetings to which parents are invited.
4. Assist the club leaders and volunteer to help the club by assisting with food preparation and taking part in leadership if called upon.
5.  Not holding any individual club staff member liable in the event of an accidental injury.
6.  Supplying necessary information on the Membership Application and Health Record.
7.  Giving our permission for the applicant to attend the KKAC activities, except as noted.
8.  Returning the field and dress shirts at the end of the year.

The KKAC will use photos/video of events for promotional and historical purposes. By participating in KKAC activities, we are granting permission for images of our child and us to be used.

In consideration of the benefits derived from membership, we waive any claim against the Kirkland Kernels Adventurer Club or the Washington Conference of Seventh-day Adventists for any accidents which may arise in connection with the activities of the KKAC.
We certify that *
Applicant's name
was born on *
MM/DD/YYYY
Signature of Father or Guardian *
Your printed name is your signature
Father's Occupation
Signature of Mother or Guardian *
Your printed name is your signature
Mother's Occupation
Date of application *
MM/DD/YYYY
Comments or Suggestions
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