PIONEER CLUB                              2006 Registration Form                                   Ages 4-Grade 5 Please print a copy of this form to fill out and return to the church. Parents/Guardians                                                                  Child's Address                                                                         Phone                                                                                      Contact in case of emergency and nobody is home:                                                                                           Name of Child                               D.O.B.                Grade                                                                                                                                                                                                                                                                      Any special instructions?  (allergies, health, etc.)                                                                                                                                                                                                                                                                                                                Signature of Parent/Guardian