PERSONAL INFORMATION

Name *

Email *

Phone *

Date of Birth *

Age *

Sex *

Polo Shirt Size

Church

PARENTS & EMERGENCY INFORMATION

Mother’s Name

Mother’s Phone Number

Mother’s Place of Employment

Father’s Name

Father’s Phone Number

Fathers’s Place of Employment

In Case of Emergency

Contact Person Name *

Emergency Contact Phone Number *

Place of Employment

OTHER INFORMATION

State Any Illness or Allergies *

Desired Instrument to Play:

Option One

Option Two

CERTIFICATION

I certify that all information on this application is complete and accurate. I agree to follow all rules and regulations of the Pathfinder Band and Pathfinder Corporation. ALL ANNUAL DUES: SIXTY DOLLARS ($60.00) FOR BEGINNERS & THRITY DOLLARS ($30.00) FOR ADVANCED.

Guardian Name *

Guardian Contact *

SECURITY

Test *

Alert!