Pleasant Valley Pathfinder Club — TLT Program Application Form

Name
Email
example@example.com
Home Phone
Cell Phone
Address
City
State / Prov.
Zip
Current Age
Birth Date

Month Day Year
Date
Home Church
Baptized?

Yes No
School Name
Grade
School Address
City
State / Prov.
Zip
Trail Companion

Friend Trail Friend Companion Trail Companion Explorer Frontier Explorer Ranger Frontier Ranger Voyager Wilderness Voyager Guide Wilderness Guide
List your participation in Pathfinder clubs as applicable:

Club #1 Name:   Club Name
Club #1 Years of involvement:   Years
Club #1 Director Name:    Director Name

Club #2 Name:    Club Name
Club #2 Years of involvement:    Years
Club #2 Director Name:   Director Name

Club #3 Name:    Club Name
Club #3 Years of involvement:   Years
Club #3 Director Name:   Director Name
Pathfinder Club Applying To
Applicant Signature

Clear
Date

Month Day Year
Date
Parent/Guardian Signature

Clear
Date

Month Day Year
Date
Should be Empty:

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