Temple Salem SDA

Child Information

Child's First Name *

Child's Last Name *

Birth Date *

Age *

Gender *

School (Optional)

Grade *

Church (Optional)

New to the Club? *

Yes

Completed Levels *

None

Little Lamb

Eager Beaver

Busy Bee

Sunbeam Builder

Helping Hands

Other

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Email *

Cell Phone *

Street Address *

City *

State/Province *

Zip/Postal Code *

Home Phone (Optional)

Please complete all required parent/guardian information to continue

Food Allergy Section

Date: 2025-04-04

Food Allergies? *

My child does not have any food allergies

My child has food allergies

Please complete all required health information fields to continue

Parent/Guardian Commitment & Payment Information

Parent/Guardian Commitment

As parent/guardian, I understand that the Adventurer Club is active and includes many opportunities for service, adventure, fun, and learning. I will support the program by:

Encouraging my Adventurer to take an active part in all club meetings and functions.
Attending events in support of my Adventurer.
Assisting club leaders by serving as a helper when needed.
Not holding any individual club staff member liable in the event of an accidental injury.
Giving my permission for the above named Adventurer to attend Adventurer activities.

I agree to the Parent/Guardian Commitment and Club Guidelines *

Parent/Guardian Signature (Type Full Name) *

Child's Signature (Type Full Name) *

Signature Date: April 4, 2025