Adventurer Club Application Form

Please fill in the Application form below

NOTE: This form can take some time to complete if you are applying for multiple children.

For your convenience, if you cannot complete the survey all at once,
there is a “Save and Continue” button at the bottom.

Use this form to apply for up to four children to join the Adventurer Club

Step 1 of 5

20%

Parent/Guardian Information

Published on 2025-06-24
On this page, we will collect information about the parent(s) / guardian(s).
This information will apply to all children you register on the following pages.

Parent/Guardian Name(s)*

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Primary Phone is a Cell Phone?*

Yes

Alternate Phone

Alternate Phone is a Cell Phone?

Yes

Email Address*

Church Name*

School Name*

Emergency and Medical Contacts

Emergency contact (friend or relative)*

First Last

Phone*

Family physician*

First Last

Phone*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Media Release Consent

Pennsylvania Conference of
Seventh-day Adventists
Adventurer & Pathfinder Ministries
2329 Mountain Rd, Hamburg, PA 19526
Phone: (610) 374-8331

I, am the parent or guardian of the child listed below, and do hereby voluntarily waive, grant, and release the right to photograph and publish pictures, audio and video of me and/or my child or children to the Pennsylvania Conference. I understand that photographs may be printed, placed on the Conference web site, or incorporated into promotional material such as brochures or videos.

I hereby waive any claim against the Pennsylvania Conference, its: Adventurer & Pathfinder Ministries and staff, for any personal or emotional damage which may arise in connection with the use of the photographs.

I understand that illegal or explicit photographs are NOT authorized under this agreement. Should such a situation arise, it is understood that it is not the result of negligence on the part of the Adventurer & Pathfinder Ministries or any of its ministries, staff, or the Pennsylvania Conference of Seventh-day Adventists. In such a case the violating individual or parties are solely liable and are subject to all local, state, and federal laws.

I understand that by signing this form, I am releasing all recorded images and audios for the express use of the Pennsylvania Conference. Neither my child nor I will receive any compensation for this now or at any time in the future. I further certify that I am the parent or guardian of the child and am over 18 years of age. And I understand that the Pennsylvania Conference Adventurer & Pathfinder Ministries and the photographer(s) will hold the copyright to all photographs.

Should I desire a copy of one or more photographs, videos or audios, I will make a request to the appropriate person in writing. I am aware that there may or will be a cost involved.

By checking “Yes” you confirm that you have read, understood, and agreed to the terms set forth in this document.

Media Release Consent*

Yes

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.

FULL NAME of parent/guardian (typed)*

Number of children to enroll in the Adventurer club*

Child 1 Information

Child 1 Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Grade*

Pre-K

Check all level(s) the child has completed*

None

Baby Bird

Little Lamb

Eager Beaver

Busy Bee

Sunbeam

Builder

Helping Hand

Medical Information

Child has had a Tetanus booster?*

Yes

I choose to not participate in vaccinations

Date of last tetanus booster*

MM slash DD slash YYYY

Allergies to drugs or foods

Medications

List any restrictions

Consent*

Authorization to Treat a Minor

In case of emergency, I hereby give permission to the physician selected by the club staff 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 form is granted.

Uniform Needs

Do they need a field uniform t-shirt*

Yes

t-shirt size*

Do they have “Class A” Adventurer Club uniform*

Yes

– If yes, are they missing anything that you know of? Please select all that apply (see image below for reference)

Scarf

Scarf Slide

Sash

Pennsylvania Conference Patch (left arm)

Adventurer World Insignia (left arm)

Sunbeam

Club Crest Insignia (right arm)

Insignia Patch (left arm)

Class Pins

Missing Class Pins (check all that apply)*

Baby Bird

Little Lamb

Eager Beaver

Busy Bee

Sunbeam

Builder

Helping Hand

Pledge
Because Jesus loves me, I will always do my best.

Law
Jesus can help me to: Be obedient, Be pure, Be true, Be kind, Be respectful, Be attentive, Be helpful, Be cheerful, Be thoughtful, Be reverent.

Applicant Commitment

I,want to join the Harrisburg Adventurer Club. I will attend meetings, activities, field trips, and other club activities.

I will proudly wear my Adventurer uniform and obey club guidelines. I will be cheerful, helpful, honest, kind, and courteous.

Child 1 Signature (full name)*

By typing my name I am agreeing to the Applicant Commitment

Child 2 Information

Child 2 Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Grade*

Pre-K

Check all level(s) the child has completed*

None

Baby Bird

Little Lamb

Eager Beaver

Busy Bee

Sunbeam

Builder

Helping Hand

Medical Information

Child has had a Tetanus booster?*

Yes

I choose to not participate in vaccinations

Date of last tetanus booster*

MM slash DD slash YYYY

Allergies to drugs or foods

Medications

List any restrictions

Consent*

Authorization to Treat a Minor

Uniform Needs

Do they need a field uniform t-shirt*

Yes

t-shirt size*

Do they have “Class A” Adventurer Club uniform*

Yes

– If yes, are they missing anything that you know of? Please select all that apply (see image below for reference)

Scarf

Scarf Slide

Sash

Pennsylvania Conference Patch (left arm)

Adventurer World Insignia (left arm)

Sunbeam

Club Crest Insignia (right arm)

Insignia Patch (left arm)

Class Pins

Missing Class Pins (check all that apply)*

Baby Bird

Little Lamb

Eager Beaver

Busy Bee

Sunbeam

Builder

Helping Hand

Applicant Commitment

Child 2 Signature (full name)*

By typing my name I am agreeing to the Applicant Commitment

Child 3 Information

Child 3 Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Grade*

Pre-K

Check all level(s) the child has completed*

None

Baby Bird

Little Lamb

Eager Beaver

Busy Bee

Sunbeam

Builder

Helping Hand

Medical Information

Child has had a Tetanus booster?*

Yes

I choose to not participate in vaccinations

Date of last tetanus booster*

MM slash DD slash YYYY

Allergies to drugs or foods

Medications

List any restrictions

Consent*

Authorization to Treat a Minor

This field is hidden when viewing the form

Uniform Needs

Do they need a field uniform t-shirt*

Yes

t-shirt size*

Do they have “Class A” Adventurer Club uniform*

Yes

– If yes, are they missing anything that you know of? Please select all that apply (see image below for reference)

Scarf

Scarf Slide

Sash

Pennsylvania Conference Patch (left arm)

Adventurer World Insignia (left arm)

Sunbeam

Club Crest Insignia (right arm)

Insignia Patch (left arm)

Class Pins

Missing Class Pins (check all that apply)*

Baby Bird

Little Lamb

Eager Beaver

Busy Bee

Sunbeam

Builder

Helping Hand

Applicant Commitment

Child 3 Signature (full name)*

By typing my name I am agreeing to the Applicant Commitment

Child 4 Information

Child 4 Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Grade*

Pre-K

Check all level(s) the child has completed*

None

Baby Bird

Little Lamb

Eager Beaver

Busy Bee

Sunbeam

Builder

Helping Hand

Medical Information

Child has had a Tetanus booster?*

Yes

I choose to not participate in vaccinations

Date of last tetanus booster*

MM slash DD slash YYYY

Allergies to drugs or foods

Medications

List any restrictions

Consent*

Authorization to Treat a Minor

This field is hidden when viewing the form

Uniform Needs

Do they need a field uniform t-shirt*

Yes

t-shirt size*

Do they have “Class A” Adventurer Club uniform*

Yes

– If yes, are they missing anything that you know of? Please select all that apply (see image below for reference)

Scarf

Scarf Slide

Sash

Pennsylvania Conference Patch (left arm)

Adventurer World Insignia (left arm)

Sunbeam

Club Crest Insignia (right arm)

Insignia Patch (left arm)

Class Pins

Missing Class Pins (check all that apply)*

Baby Bird

Little Lamb

Eager Beaver

Busy Bee

Sunbeam

Builder

Helping Hand

Applicant Commitment

Child 4 Signature (full name)*

By typing my name I am agreeing to the Applicant Commitment

Consent

I agree to the privacy policy.

Please fill in the Application form below

NOTE: This form can take some time to complete if you are applying for multiple children.