Pioneer Clubs Registration

Please fill out this form and click SUBMIT below, one for each child.

After Submitting a form, you can click on RETURN TO FORM, to begin the next child.
 
 
Please select one option.
 
 
If your Mobile Phone is also your Home Phone, please enter it here and check the 'Yes' box below

 
Please select one option.
 
 
 
 
Please select one option.
Please select one option.
Emergency Contact Information if parent/guardian listed above cannot be reached

 
 
 
Health Information / Allergies

Please select all that apply.
 
 
 
 
Transportation Information

Please select one option.
 
Please select one option.
 
Photo Use Permission

As a parent / legal guardian of the above named student, I consent to the use of any audio, videos, or photographs of my child that may be taken during Pioneer Club meetings and event(s) during the year for promotion of Pioneer Club at East Side Baptist Church. Photos may be used for our Pioneer Club FB page (which is a closed, by invitation only page), bulletin boards, crafts, slide shows, presentations, etc.

Please select one option.
Transportation Permission

As a parent / legal guardian of the above named student, I give my permission for my student to be transported on the church van to & from East Side Baptist Church for Pioneer Club Activities (3rd grade and up only).
Please select one option.

Description

Please fill out this form and click SUBMIT below, one for each child.

After Submitting a form, you can click on RETURN TO FORM, to begin the next child.