Little Sentinels Adventurer Club Enrollment Form 2026-2027

Welcome to the Elmhurst Little Sentinels Adventurer Club of 2026-2027!

We are thrilled to have you and your child join us in this exciting journey. The Adventurer Club is a program created by the Seventh-day Adventist Church to support parents in the challenging task of raising children. It provides fun and creative ways for children to develop strong values, learn new skills, and make lasting friendships—all within a Christ-centered environment.

Please kindly take 15-20 minutes to fill out this club membership registration and health record form. This information is essential to ensure the safety and well-being of your child while participating in our activities.

Enrollment Fee: Please keep in mind that a flat fee of $40 per child will be required for membership. Additional fees may incur for new uniforms and T-shirts your child needs one. Payment instructions will be provided soon.

After registering your child, please be sure to attend our first club meeting and parent orientation on Saturday, August 8, 2026 at 2:30 PM. This will be at the Elmhurst SDA Church located at 246 W Butterfield Rd, Elmhurst, IL 60126. Your Adventurer will participate in an activity/award, and parents will be meeting to discuss expectations and receive important information regarding the club year.

For any questions or further assistance, please feel free to contact our Club Director, Alice Perez at 708-552-3838.

Thank you for being a part of the Elmhurst Little Sentinels Adventurer Club. We look forward to a wonderful year ahead!
ELMHURST LITTLE SENTINELS ADVENTURER CLUB

ENROLLMENT FORM FOR THE 2024-2025 YEAR
Who is completing this form for the Adventurer Applicant?

First NameLast Name
Email address to receive a receipt of this form.
example@example.com
CHILD'S INFORMATION:
Child's Name
Child's Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Age
Child's School Grade Level
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School
Home Church
PARENT/GUARDIAN'S INFORMATION:
Parent / Guardian #1 - Full Name

First NameLast Name
Parent / Guardian #1 - Home Phone
Format: (000) 000-0000.
Parent / Guardian #1 - Cell Phone
Format: (000) 000-0000.
Parent / Guardian #1 - Email
example@example.com
Parent / Guardian #2 - Full Name

First NameLast Name
Parent / Guardian #2 - Home Phone
Format: (000) 000-0000.
Parent / Guardian #2 - Cell Phone
Format: (000) 000-0000.
Parent / Guardian #2 - Email
example@example.com
ADVENTURER PLEDGE

Because Jesus loves me, I will always do my best.
ADVENTURER LAW

Jesus can help me: Be obedient, Be pure, Be true, Be kind, Be respectful, Be attentive, Be helpful, Be cheerful, Be thoughtful, Be reverent.
I (Child's Full Name)
want to join the
I will attend meetings, activities, field trips, and other club activities. I will proudly wear my Adventurer uniform and obey club guidelines. I will be cheerful, helpful, honest, kind, and courteous.
Signature of Adventurer
As parent, I 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. Attending and participate in meetings/activities with my child.

2. Assisting club leaders/teachers by serving as a helper when needed.

3. Not holding any individual club staff member liable in the event of an accidental injury.

4. Giving my permission for the above named Adventurer to attend Adventurer activities.
Signature of ParentGuardian
Publicity Consent
I ______________ give the Elmhurst Seventh-Day Adventist Church my permission to use my child's photograph or video taken during Adventurer Club events, meetings, and outings in any and all publications, advertising, news media, video, world wide web materials and future media for CLUB PURPOSES. I understand and agree that these materials may be kept on file and/or used by the Elmhurst Seventh-Day Adventist Church for potential future uses. I agree to release Elmhurst Seventh-Day Adventist Church from any and all liability arising from or in connection with the taking, use, publication or dissemination of such materials.
HEALTH RECORD FORM

Please kindly fill out the following information regarding your child's health.
Child's Full Name
Child's Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Complete the Following: If yes to any of the following, please check

Other
Allergies - Please describe any allergies to food / medications and the type of reaction. If no allergies, write NONE.
Current medications child uses. If no medications, write NONE.
Date of last Tetanus Immunization Booster

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Permission to Administer Tetanus Immunization / Booster If Needed
Approved over the counter medications
Physical Restrictions Abnormalities - Describe
Emergency Contact Name & Phone (friend or relative)
Format: (000) 000-0000.
Family Physician Name
Family Physician's Address

Family Physician Address

Street Address Line 2

CityState

Zip
Family Physician Phone
Format: (000) 000-0000.
Adventurer insurance coverage is to cover medical expenses up to a capped amount per person for injuries that occur to a Adventurer or Adventurer Staff Member while such a person is attending an approved Adventurer event or activity. Therefore, the above-named Adventurer's family health insurance is:
Insurance Company
Insurance Policy Number
Authorization to Treat a Minor

In the event emergency medical treatment becomes necessary for my child, we/l grant the Adventurer Club director or his/her assistants authority to obtain such emergency medical assistance. We/l further grant permission for medical personnel to administer emergency medical treatment. This consent shall remain in continuous effect until revoked in writing and delivered to the above-named director or to the club entrusted with the custody of said minor.
Child's Full Name

First NameLast Name
Parent / Guardian Signature
Any questions, comments, or concerns?
Should be Empty:

ELMHURST LITTLE SENTINELS ADVENTURER CLUB

ADVENTURER PLEDGE

ADVENTURER LAW

Publicity Consent

HEALTH RECORD FORM