- Silverdale Lutheran Church - Silverdale, Washington

Join the fun at Vacation Bible School this summer! We are saving a seat for YOU at the table! This camp is offered for FREE to our community.

July 29-August 1 • 9am-noon Pre-k thru 5th grade

Click here to volunteer for VBS!

VBS YOUTH Registration Form 2024

Family Name*
Last
Child 1 Name*
First
Gender*
Birthdate*
Grade entering in the fall
Child 2 Name
First
Gender
Birthdate
Grade entering in the fall
Child 3 Name
First
Gender
Birthdate
Grade entering in the fall
Additional information for all children
Please provide any additional information you deem helpful about your child.
Parent/Guardian Name(s)*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Best Contact Phone Number*
Alternate Phone Number
Email*
Home Church

The church at which you regularly attend or hold membership
Photo Release*
Photo Release
I hereby grant permission to Silverdale Lutheran name) to use photographs and/or video of my child(ren) taken during Vacation Bible School (VBS) at Silverdale Lutheran Church. These photos and videos can be used in Silverdale Lutheran publications both print and digital, as well as social media. and in other communications related to the mission of Silverdale Lutheran Church.
Medical Release
Please fill out the section below before submitting. Your child is not fully registered until the medical release information is complete.
Physician's Name*
First Last
Physician's Phone*
Insurance Company*
Insurance Policy Number*
Allergies / Reactions / Special Health Considerations / Dietary Restrictions & important information*
Please type "none" if not applicable
Consent*
Consent for emergency medical treatment
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.

VBS YOUTH Registration Form 2024

Medical Release