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Registracion del Participante

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Our Saviour's Lutheran Church

Location

27201 99th Ave. NW

Stanwood, WA 98292

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Contact Brenna Karp:

360-629-3767

vbs@oslcstanwood.org

Primero, cuéntenos sobre usted:

Información de los Padres

Label

Nombre

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Apellido

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Correo Electrónico

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Dirección 1

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Dirección 2

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Ciudad

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Estado/Provincia

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ZIP/Código Postal

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País

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Teléfono de Contacto 1

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Teléfono de Contacto 2

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Nombre del Contacto de Emergencia

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Relación del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Nombre de recogida alternativo

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Teléfono de recogida alternativa

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Cuéntanos sobre tu participante

VBS is for kids entering Pre-K - 5th grade. In order for proper safety precautions to be taken, the child MUST BE potty trained and age 4 (Pre-K) as of August 31st, 2026. Please register your child's grade for fall of 2026. Allergy box - please enter N/A if none, thank you.

Nombre

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Apellido

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Grado Entrando

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Género

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Fecha de nacimiento

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Talla de Camisa

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Alergias

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Preocupaciones Médicas

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¿Tienes amigos con los que te gustaría estar juntos? Haremos todo lo posible para juntar a los amigos seleccionados en el mismo grupo, pero no podemos prometer que todas las solicitudes serán posibles.

Amigo 1 Nombre

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Amigo 1 Apellido

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Comentarios

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Consent to Medical Care & Treatment of Minor: This health history is correct and the best of my knowledge. The person herein described has my permission to engage in all prescribed activities except as noted. The following authorization empowers the staff of OSLC, Stanwood, WA and youth group adult leaders to take whatever steps they deem necessary to ensure the well-being of my child should a medical emergency occur during VBS. Every attempt will be made to contact the child's care-givers and/or emergency contact provided. I _______________________ (Parent/Legal Guardian typed name equates to Signature) do hereby authorize OSLC Children/Youth Group to take necessary emergency measures in the treatment of (participant): ____________________ if needed. My child is in good physical health and does not have any conditions or disabilities which may be aggravated except as noted on this form. In the event that I cannot be reached in an emergency, I hereby authorize the physician selected by OSLC, Stanwood, WA to hospitalize, secure proper treatment for, and order injections anethesia and surgery for my child named above. Please enter parent/guardian name and participant's name in the box as authorization.

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Health Insurance Company

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Policy or Plan #:

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Participant's Medical # (if applicable)

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Does this participant have any physical, psychiatric, emotional, or behavioral conditions of which the youth group adivisor should be aware? If so, please list.

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Regularly prescribed medications & doses: (if none, please write N/A to continue)

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Allergies to drugs or special diet? (if none, please write none to continue)

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Doctor's Name and Phone Number:

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Photo Release: Our Saviour's Lutheran Church (OSLC) has Children/Youth social media pages where photos and videos from VBS events are periodically published. We also have a Youth Group bulletin board where we sometimes post photos from events. It is OSLC's policy that photos of children are never published with names or other identifying information. Please select yes, you can use pictures and videos of my child or No, you cannot use pictures. Please note: We will have a daily spot where we would like to use the kids pictures each day at the end of our time together.

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