Adventure Club Registration
Child's Name
First Name
Last Name
Gender
Male
Female
Parent / Guardian Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Current Age of Student
Last Grade Completed
Entering Kinder
Kinder
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies:
Date of Birth
-
Month
-
Day
Year
Date
Emergeny Contact
Name
Emergency Contact Phone #:
Phone
Who can pick up your child?
Person Name
Name of Home Church
Church Name
Do you give us permission to video and/or take photos of your child?
Yes
No
My Products
prev
next
( X )
Returning Clubber
$20.00
$
20.00
This covers membership for the 2026-2027 year!
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
New Clubber
$30.00
$
30.00
This includes, membership, bag & book.
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$0.00
$
0.00
Submit
Should be Empty: