Frederick Firefox Pathfinder Club Application

Frederick Firefox Pathfinder Club Membership Application
I would like to join the Frederick Firefox Pathfinder Club. I will attend the club meetings, hikes, camping and field trips, Missionary adventures, I agree to be guided by the rules of the club and the Pathfinder Pledge and Law.
Pathfinder Signature

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Pathfinder Pledge

By the Grace of God,

I will be pure, kind and true

I will keep the Pathfinder Law

I will be a servant of God

And a friend of Man
Pathfinder Law
1. Keep the Morning Watch
2. Do my honest part
3. Care for my body
4. Keep a level eye
5. Be courtous and obedient
6. Walk softly in the sanctuary
7. Keep a song in my heart
8. God on God's errands
Pathfinder Name*

First NameLast Name
Phone Number
E-mail*
example@example.com
Where are you a member or attending?*
Check all that apply

I have been a Pathfinder?My Dad is a Master GuideMy Mom is a Master GuideMy Dad has been a PathfinderMy Mom has been a Pathfinder
Parent Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where is your Church Membership?*
Approval by Parents or Guardians

The applicant must be in at least the 5th grade as a junior Pathfinder, or age 13 as a Teen Pathfinder.

We have read the Pathfinder Pledge and Law and are willing and desirous that the applicant become a Pathfinder. We will assist the applicant in observing the rules of the Pathfinder organization. In conideration of the benefits derived from membership, we hereby voluntarily wiave any claim against the club or the Chesapeake Conference of Seventh-day Adventists for any accidents which may arise in connection with the activities of the Pathfinder club.

As parents we understand that the Pathfinder Club program is an active one for the applicant. It includes many opportuniites for service, adventure, and fun. We will cooperate:
1. By learning how we can assist the applicant and his leaders.
2. By encouraging the applicant to take an active part in all activities
3. By attending events to which parents are invited.
4. By assisting club leaders and by serviing as leaders if called upon.
5. By purchasing Pathfinder insurance through the club treasurer.
6. By supplying needed information on the Membership Application and Health Record.
We hereby certify that applicants name was born onDate.

Signature of Father or guardian Father's or guardian's occupation

Signature of Mother or guardian Mother's or guardian's occupation

Date of application

Pathfinder Health Record
Name:First Name*   Last Name*   .
Birth Date:Date
Date of Last Tetanus Booster:   Date
Allergies to drugs or food:*
Special medications or pertinent information:*
List of restrictions:*
Father's Cell Phone:
Please enter a valid phone number.
Father's Work Phone:
Please enter a valid phone number.
Mother's Cell Phone:
Please enter a valid phone number.
Mother's Work Phone:
Please enter a valid phone number.
Emergency Phone (friend or relative)
Please enter a valid phone number.
Family Physician Name:

First NameLast Name
Family Physician Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family Physician Phone:
Please enter a valid phone number.
Insurance Company Name (In case of injury)
Insurance Company Policy Number (In case of injury)
For Internal use only
Authorized to treat minor
I/we the undersigned parent, parents or legal guardian of:
First Name*   Last Name*
In case of emergency, I hereby give permission to the physician selected but eh club directors to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child.

As parent or legal guardian of the applicant, I am in favor of him/her attending club functions and accept the conditions named. The health history is correct so far as I know, and the person heron described has permission to engage in all prescribed club activities except as noted. In addition I have read and understand the Emergency Authorization statement and give my full consent to the terms found therein. Permission for photo copying of this health record is granted.
Date   Parent/Guardian Signature*

This section is for the notary to sign if your state requires it:
Signature

Frederick Firefox Pathfinder Club Membership Application

Pathfinder Health Record