Mile End Community Church > Kids Kingdom > Pathfinders > Pathfinder Club - Registration

Mile End Pathfinder Club

Registration Form


Name of Pathfinder *
Address *
City *
State *
Postcode *
Phone Number
E-mail *
School *
Grade *
Church
Date of Birth *
Age (minimum age at beginning of the year is 9 years & 9 months) *
I would like to join the Mile End Community Church (MECC) Pathfinder Club *
 Yes
Have you been a Pathfinder before? *
 Yes
 No
If yes, where?
Please tick the classes you have completed
 Friends
 Companion
 Explorer
 Ranger
 Voyager
 Guide
What class do you wish to join? *
Do you have a full uniform? *
 Yes
 No
If no, what items would you require?
Basic Medical Details
Medicare Number *
Health Fund
Last Tetanus injection *
Any known medical condition *
 Yes
 No
If yes, please provide more details
Medication
Allergies to
 Plants
 Bee Stings
 Food
Anaphylaxis *
 Yes
 No
If yes, please provide a copy of action plan to Club Director or Admin
Asthma *
 Yes
 No
If yes, please provide a copy of action plan to Club Director or Admin
Any disability or impairment *
 Yes
 No
If yes, please provide more details
Level of swimming ability *
 None
 Basic
 Confident
 Advance
To be completed by parents/guardians
Name of Parents/Guardians *
Address *
City *
State *
Postcode *
Phone Number *
E-mail *
Church
As a parent/guardian I have worked with Pathfinders in the following activities (please provide name of club/church)
I am willing to assist Mile End Pathfinder Club in (note that a current WWCC number is needed)
 Craft activities
 Pursuit activities
 Honours
 Other
If Other, please specify
Emergency Contact
Emergency Contact Name *
Relationship to child *
Phone Number *
Declaration
I have read the requirements for membership in the Mile End Pathfinder Club and hereby certify that my child has reached the age of ten years and over. We are willing and desirous that he/she becomes a Pathfinder. *
 I certify
As parent/guardians, we understand that the Pathfinder Club Program is an active one for the applicant. It includes many opportunities for service, adventure and fun. *
 I understand
In the event of accident or illness, I also authorise the Club Director to consent any medical treatment by a licensed physician and/or surgeon. I agree to pay the appropriate fees for such and any ambulance or other emergency transportation costs, which may be required. *
 I authorise
I agree to meet the expense of my child returned home by the director or leaders. *
 I agree
I give permission to use photos of my child for promoting and reporting purposes. *
 Yes
 No
I agree for my child to attend Mile End Pathfinder Club activities on this understanding. *
 I agree
Registration
Registration Fee *
 $75.00
Uniform Order
Field Uniform Shirt
Mile End Name Badge
Sash
 
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