- Silverdale Lutheran Church - Silverdale, Washington

High School Backpack Trip to the Ozette Triangle, August 16-18th. (9-12th grade)

Name(Required)
First Last
Phone(Required)
Email(Required)
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Grade & age(Required)
Emergency Contact(Required)
First Last
Best Contact Phone Number(Required)
Experience hiking and backpacking(Required)
Please answer this question then review the list of gear that is needed for this trip.
Medical Release
Please fill out the section below before submitting.
Physician's Name(Required)
First Last
Physician's Phone(Required)
Insurance Company and Policy number(Required)
Allergies / Reactions / Special Health Considerations / Dietary Restrictions & important information(Required)
(add n/a) if no allergies
Consent for medical treatment(Required)
I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached by Silverdale Lutheran Advisors in the case of an emergency. I agree to pay all medical costs in such emergency treatment.
Email
This field is for validation purposes and should be left unchanged.

Medical Release