Ingleside Presbyterian Church
Pioneer Clubs 2010-11
Club Members Registration Form

Please fill out one form for each child you are registering
(required fields marked with an *) 

Child Information: 
First Name*:  Last Name*: 
Current Grade/Age*:  Birthdate*: 
Allergies/Conditions/Special Instructions: 

Parent/Guardian Information: 
Name*: 
Street Address*: 
City*:  State*:   Zip*: 
Primary Contact Number*:  Alternate Contact Number: 
Parent/Guardian Email Address: 

What is the best way to communicate with you (phone, email, in-person):   

Emergency Contact: 

  
Name*:  Phone Number*: 
Relationship to child: 

Parent Questionnaire 

List three interests your child has:

What do you hope your child will gain from Pioneer Clubs socially, physically, etc?

What would you like Pioneer Clubs to provide for your child spiritually?   

Please list other information leaders should know about your child.

Occasionally leaders could use help from parents.  In what ways would you be willing to participate in club (i.e. provide snack, assist with songs/games, take photos, provide outing transportation, help organize outings/events, fill in for leaders, help with activity awards, talk about another country/culture or others)?  

How often would you be willing to participate? 

What club special events would you be most interested in attending?