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Registration Forms

Parent:  Please print, fill-out and sign then return to Director/Deputy Director



Statesville Pride Pathfinder Club Membership Application


Pathfinder Name ______________________________________________________________________


Parent Names ________________________________________________________________________


Address _____________________________________________________________________________


Home Phone _________________________  Cell Phone ____________________ Do you text?  ______


Email _______________________________________________________________________________


School ______________________________  Grade ________  AY Class _________________________




New Pathfinders:    $50.00  

Returning PF:         $25.00


**  New Pathfinders will be issued a club owned uniform shirt, belt and scarf/slide as part of their Class A uniforms.  We are lending the uniform to you in goodwill.  If it is damaged or not returned, the Pathfinder will be charged the current cost of replacement at Advent Source.   


**  Periodically throughout the calendar year each Pathfinder will be charged a nominal fee for all camping trips and various honors.  Charges will range from $5 to $20.  


** As with all things financial, please see the club Director or Deputy Director if there is any hardship or issue.  The Statesville SDA Church has set aside money specifically to meet the needs of a worthy Pathfinder.  


I understand and willingly accept the responsibility for the financial portion of my Pathfinder’s participation in the Statesville Pride Pathfinder Club.  


_________________________________________________    _____________________

Parent/Guardian Signature                                                     Date




Birthdate: ____________________________  Date of last Tetanus Booster _________________


Allergies to drugs or food:  ________________________________________________________




Special medications or pertinent information: _________________________________________



List of restrictions: ______________________________________________________________




Emergency Contact info: _________________________________________________________


Insurance Company info: _________________________________________________________


Insurance Policy Number: ________________________________________________________


Family Physician Name/City ______________________________________________________


Family Physician Phone  _________________________________________________________


Authorization to Treat a Minor


I (we) the undersigned parent, parents or legal guardian of: ______________________________

In case of emergency, I hereby give permission to the physician selected by the 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 stated is correct so far as I know, and the person herein 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 photocopying of this health record is granted.


____________________    ______________________________________________________

Date                                    Parent/Guardian Signature   


Approval by Parents or Guardians:


The applicant is at least 10 years of age and in the 5th grade.  We have read the Statesville Pride handbook and will assist the applicant in observing the rules of our Pathfinder organization.  In consideration of the benefits derived from membership, we hereby voluntarily waive any claim against the club or the Carolina 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 will cooperate:

    1) By learning how we can assist our Pathfinder and his/her leaders.
2) By encouraging the applicant to take an active part in all activities.
3) By getting our Pathfinder to meetings on time and in uniform
    4) By attending events to which parents are invited.

    5) By assisting club leaders and by serving as leaders if called upon.



________________________________________        ______________________________

Parent’s Signature                                                            Date



Approval by Pathfinder:


I would like to join the STATESVILLE PRIDE PATHFINDER CLUB.  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 Signature                                                           Date


Pathfinder Pledge                             Pathfinder Law


By the grace of God,                       1.    Keep the Morning Watch

I will be pure, kind and true              2.    Do my honest part

I will keep the Pathfinder Law          3.    Care for my body

I will be a servant of God                 4.    Keep a level eye

And a friend to man.                        5.    Be courteous and obedient

                                                         6.    Walk softly in the sanctuary

                                                         7.    Keep a song in my heart

                                                         8.    Go on God’s errands