Adventurer Club Registration Form

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Please answer all questions to register your child for Adventurer Club. Registration fee of $15/child is highly recommended but not required. Fee helps to pay for shirt, badges, club supplies. Adventurer Club will starts September 6, 2023 at 6:30pm. If you have questions, contact Nicole Houdek at nhoudek83@gmail.com or 402-440-4460.

Email *

Child's Name *

Birth Date *

Address *

Phone Number *

Grade (Pre-k to 4th) *

1st Grade

2nd Grade

3rd Grade

4th Grade

Kindergarten

Pre-K

Parent/Guardian Name(s) *

Parent/Guardian Email *

Parent/Guardian's address (if different than child's)

Home Church *

Allergies to drugs or foods *

Medications *

List any restrictions *

Emergency contact & phone number (friend or relative) *

Family Physician *

Physician's address *

Shirt Size *

XXL

Send me a copy of my responses.

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