Parent: Please print, fill-out and sign then return to Director/Deputy Director
Statesville Pride Pathfinder Club Membership Application
Pathfinder Name ______________________________________________________________________
Parent Names ________________________________________________________________________
Home Phone _________________________ Cell Phone ____________________ Do you text? ______
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.
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 heart8. Go on God’s errands