BWM Adventurer Application & Health Records 2025-2026

BWM Shining Star 2025-2026 Year Adventurer Registration Form
Club Name
Directors Name
Church Name
Applicant Name (Child's name)
Birth date

MonthDayYear
Date
Age
Grade
Mailing Address
Cell Number
Emergency Contact Name
Emergency Contact Number
Format: (000) 000-0000.
Applicant Information - Check class(es) child has been invested in:
I, (Childs Name)
want to join the (Club name)
I will attend meetings, activities, field trips, and other activities. I will proudly wear my Adventurer uniform and obey club guidelines.
Signature of Child (Applicant)
Health Information:

The following information is critical for the safe care of your Adventurer during routine club activities and emergencies. Please make sure to answer each question by circling either “yes” or “no” and list any information that applies to the care/safety of your child.
Does your child have any allergies to foods/medications?
If yes please list
Is there any physical restrictions that would affect your child during club activities? List if yes
If yes please list
Does your child have any health history? (Asthma, Diabetes, etc)
If yes please list history
Approval/Consent of Parent/Guardian

As parent/guardian, we understand that the Adventurer program is an active one which includes many opportunities for service, adventure, fun, and learning. I will support the program by:

1. Encouraging my Adventurer to take an active part in all club meetings and functions.

2. Attending events to which parents are invited in support of my 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 an accidental injury.

5. Giving my permission for the above-named Adventurer to attend all club activities.
Signature of Parent
Parent Name
Parent Cell #
Home Address
Parent E-mail Address
example@example.com
Should be Empty:

BWM Shining Star 2025-2026 Year Adventurer Registration Form

Health Information: