Torchbearer Registration Form

Torchbearer Pathfinder Club Membership Application
Pathfinder Information

Completed by Pathfinder (with help of adult)
Name*

First Name Last Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Birth Date:*

MonthDayYear
Gender:*

MaleFemale
T-shirt size*
School:*
Grade:*
Baptized?*
Church:
Primary Contact E-mail (can be Pathfinder or guardian)
Primary Contact Phone Number (can be Pathfinder or guardian)

Area CodePhone Number
Phone Type:

I would like to join the Torchbearer Pathfinder Club, sponsored by the Walla Walla University Church. I will attend club meetings, hikes, camping and field trips, missionary adventures and other club activities. I agree to be guided by the rules of the club and the Pathfinder Pledge and Law.

Pathfinder Pledge		Pathfinder Law
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 to man.		Keep the Morning Watch Do my honest part Care for my body. Keep a level eye. Be courteous and obedient. Walk softly in the sanctuary. Keep a song in my heart. Go on God's errands.

Pathfinder's Signature (not parent or guardian):

Clear

Pathfinder Questionnaire

(to be completed by Pathfinder)
What are some of your favorite kinds of food?
What activities/hobbies/sports do you enjoy?
What pet peeves do you have (things that annoy you)?
If you have been in Pathfinders before what are your favorite parts?
If you have been in Pathfinders before what parts would you like to change?
What are some qualities you like about yourself?
What are you goals for being in Pathfinders?
Are there any honors you would particularly like to do this year?

Parent/Guardian Information

To be completed the applicant's parent or guardian
Parent/Guardian 1 Name:*

First NameLast Name
Relation:*
Phone:*
Please enter a valid phone number.
Guardian 1 Email:*
example@example.com
Guardian 1 has been a Pathfinder?

Yes, and have a Master GuideYesNo
Parent/Guardian 2:

First NameLast Name
Relation:
Phone:
Please enter a valid phone number.
Email:
example@example.com
Guardian 2 has been a Pathfinder?

Yes, and have a Master GuideYesNo
The applicant must be at least 10 years of age or in the 5th grade.

We have read the Pathfinder Pledge and Law and are willing and desirous for the applicant to become a Pathfinder. We will assist the applicant in observing the rules of the Pathfinder organization. In consideration of the benefits derived from membership, we hereby voluntarily waive any claim against the club, its volunteer staff, the Walla Walla University Church or the Upper Columbia 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 opportunities for service, adventure and fun. We seek to participate by:
1. Learning how we can assist the applicant and his/her leaders.
2. Encouraging the applicant to take an active part in all activities.
3. Attending events to which parents are invited.
4. Assisting club leaders and by serving as leaders if possible.
5. Purchasing Pathfinder insurance through the club treasurer when necessary.
6. Supplying the needed information ont he Membership Application and Health Record.
Parent/Guardian Pledge*

I have read and agree to the above parent/guardian pledge.
Parent or guardian signature here:

Clear

Pathfinder Health Record & Consent to Treat

Required to be completed and signed by the applicant's parent or guardian
List any known allergies to drugs or food (or enter "None")*
List any other health concerns or issues (or enter "None")*
Date of last Tetanus shot (leave blank if not vaccinated)

MonthDayYear
Date
Permission to give medication (throat lozenges or Acetaminophen) at my child's request?*

YesNo
Non-Parent/Guardian Emergency Contact (used if parent/guardians cannot be reached)*

First NameLast Name
Emergency Contact Relation:*
Emergency Contact Phone *
Please enter a valid phone number.
Family Physician/Pediatrician:*

First NameLast Name
Name of physician's office:*
Physician Phone Number:*
Health Insurance Company:
Health Insurance Group Number:
Health Insurance Policy Number:
I the undersigned parent or guardian do hereby consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital service that may be rendered uner the general or special instruction of physician listed above or any physician selected by the club directors, at the said physician's office or at a licensed hospital.

It is further understood that this consent is given in advance of any specific diagnosis or treatment which might be required and is given to authorize the Torchbearer Pathfinder Club or the physician to exercise their best judgement for treatment. Reasonable effort will be made to contact the family doctor/pediatrician listed above.

We hereby authorize any hospital, physician, or other person who has attended or examined the minor to furnish to General Converence Insurance Service, or its representative, any and all information with respect to any illness, medical history, consultation, prescriptions or treatment, and copies of all hospital or medical records. A copy of this authorization (including an electornic copy) shall be considered as effective and valid as the original.

As a parent or legal guardian of the applicant, we are in favor of him/her attending club functions and accept the conditions named. The health history stated above is correct so far as we know, and the person herein described has permission to engage in all prescirved club activities except as noted.

This form is in effect for one year from its signing or until such time as the parent or guardians request, in writing, that it be terminated.
I have read and agree to the terms of this medical treatment authorization.

Clear

Uniform Rental Agreement

Required to be signed by the applicant's parent or guardian
The Pathfinder Dress Uniform consists of Pathfinder shirt and accessories (necessary patches, belt/buckle, scarf, and slide), black pants or skirt, black socks, and dress shoes. The Pathfinder dress shirt and its accessories can be rented from the club for $35/year (included in the yearly registration fees). Upon completion of the Pathfinder year in May, we ask that each Pathfinder returns the complete uniform shirt in excellent condition.

Using the rental system eliminates the need for the Pathfinder to buy new uniforms as they grow. The dress shirt, complete with all necessary patches, belt/buckle and scarf cost a little more than $50 depending on size, and takes some time to sew on the appopriate patches.

If a staff member or pathfinder prefers, they may buy their own uniform and patches directy from https://adventsource.com and we will supply the Conference and Club patches for $10-$15. This makes the most sense if the Pathfinder is done growing and would like a new uniform to keep.

Either way, the Pathfinder is responsible for providing black pants or skirt, black dress shoes, and black socks.
Uniform Agreement Pledge*

I, as parent or guardian of the perspective Pathfinder applicant, understand the importance of returning the uniform and agree to pay $50 for the uniform if we fail to return it in reasonably good condition.

Parent Questionnaire

(To be completed by parent or guardian)
Describe any of your Pathfinder's extracurricular activates/classes:
Describe your child's hobbies or other interests:
Are there any social situations that could be uncomfortable for your child that we should know about?
Tell us about your child's personality, his/her strengths, and what motivates him or her.
Share any concerns
What are your expectations/goals for this year in Pathfindering?
Who may take your child home? (include yourself)*
Is there anyone your child specifically should NOT go home with?
Photo Release
Permission*

I give permission for my child/children's photos to be included on the Club's website, social media, and in print or online marketing materials including local newspapers, magazine articles, or letters related to Pathfinder activities.I do not give permission for my child's photo to be used.
Once you submit your application, we will contact you shortly to complete your membership application. Thank you!
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Torchbearer Pathfinder Club Membership Application

Pathfinder Information

Pathfinder Information

Pathfinder Questionnaire

Parent/Guardian Information

Pathfinder Health Record & Consent to Treat

Uniform Rental Agreement

Parent Questionnaire

Parent Questionnaire

Photo Release