SECC CLUB MINISTRIES

SECC CLUB MINISTRIES

Registration/Insurance Form
This application is for:*

Pathfinder ClubAdventurer Club
SELECT A CLUB POSITION:
STAFF

DirectorAssistant DirectorSecretaryInstructorOther
MEMBER (check if applicable)

TeenMaster Guide
APPLICANT'S INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Grade in School*
Age*
Birth Date*

MonthDayYear
Date
School you Attend*
Name of School
Church you Attend
Name of Church
Are you Baptized?*

YesNo
APPLICANT'S AGREEMENT
I, First Name* Last Name*, want to join the Corona Main Spanish Pathfinder/Adventurer Club. I will attend all "Share Your Faith" activities, outings, and other club activities unless I am ill. I will proudly wear my Pathfinder/Adventurer uniform. I will bey club rules and understand that they have been made for my safety and that of my peers. I will be cheerful, helpful, honest, kind, and courteous.
Applicant's Signature*

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APPROVAL/CONSENT OF PARENT/GUARDIAN
As parent(s)/guardian(s), I/we understand that the Pathfinder/Adventurer program is an active one, which includes many opportunities for service, adventure, fun and learning. I/we will support the program by:
1. Encouraging my Pathfinder/Adventurer to take an active part in all in-person/virtual club meetings and functions
2. Attending all in-person/virtual events to which parents are invited in support of my Pathfinder/Adventurer
3. Assisting club leaders by serving as a helper when needed
4. Not holding any individual club staff member liable in the event of injury
5. Giving my permission for the above named Pathfinder/Adventurer to attend all in-person/viirtual Pathfinder/Adventurer activities
6. Paying Southeastern CA Conference registration/insurance fees in the amount of $10.00
7. Paying local club fees in the amount of $15.00
Further, I/we understand by agreeing to allow the minor to participate in online activities identified above involve certain risks associated with only activity. In addition, the sponsoring organization stated above cannot guarantee that participation in this online activity will not expose your hardware to viruses, and other malicious software or code-based tools. I/we still wish to proceed with the activities described herein I/we do so and assume all risk and understanding of the risks involved. I/we fully understand the sponsoring organization cannot fully protect me, my child, or my computer systems, including software and hardware. Any technical support for my computer systems, the use of any software only computer systems or accessed through the internet are my sole responsibility. I understand that supervision of what my child accesses online, the information they share, and any messages with volunteers, employees, other parents and other minors are my responsibility. I/we agree to fully supervise all activities the minor participates in and to screen and assume responsibility for all messages my child sends and receives. I/we have read and understand the foregoing.
Please check below to indicate the participation of minor identified above.*

I give permission for the minor to participate in Pathfinder/Adventurer Club in-person/virtually with the sponsoring organization.I do not give permission for the minor to participate in the Pathfinder/Adventurer Club in-person/virtually with the sponsoring organization.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

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Date*

MonthDayYear
Date
Total of Registration

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USDRegistration Fee
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SECC CLUB MINISTRIES

APPLICANT'S INFORMATION

APPLICANT'S AGREEMENT

APPROVAL/CONSENT OF PARENT/GUARDIAN