VBS Registration & Volunteer Signup
Dates: June 20-24, 2022
When: 9am to noon
Where: Emmanuel Lutheran Church, 1036 W. A Street, Moscow
Phone: (208) 882-3915
Email: youth@elutheran.church
Website: https://elutheran.church/
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Thank you for registering! If you have more than one child attending, please complete one online registration per child.

VBS Campers are children participating in VBS who are entering Kindergarten to 5th grade this fall.

Youth Helpers are entering 6th grade & up in the fall. What does a YOUTH HELPER do? Be relational with kids! Connect and care for campers. Learn their names. Lead campers in small groups to daily activities. Be enthusiastic! Help bring energy to games, songs, workshop, etc. Set a good example for campers. Help with camp organization and space transitions.
Is your child? *
Child's Last Name *
Child's First Name *
Grade Entering in Fall 2022 *
Birthdate *
Mailing Address *
Parent/Guardian Name (First and Last) *
Phone # *
Email *
Emergency Contacts
Emergency contact in case parent cannot be reached. List name and phone: *
People authorized to pickup child. List name and phone: *
People who are NOT authorized to pickup child:
Please tell us how we can help your child have a successful week at camp:
Snack Preferences
A mid-morning snack will be offered daily.
Dietary restrictions *
Medical Information
The following information is provided for any licensed physician, dentist,  or hospital not having access to our (my) child's/ward's medical history
Medication, Food, & Other Allergies
Medication(s) currently being taken
Epi-Pen *
Description of any limitations or restrictions on camp activities
Medical Insurance Company *
Medical Insurance ID number *
Permissions & Liability Release
I have requested that Lutherhaven Ministries and Emmanuel Lutheran Church enroll my child/ward, as named above, as a participant in an activity-based camp, program or activity sponsored by Lutherhaven Ministries and Emmanuel Lutheran Church at one of its camps or sites. As a condition of participating in this camp, program or activity, I, the undersigned, do hereby agree on behalf of my child/ward, as named above, to the following:

Known & Unknown Risks
I understand that my child’s/ward’s presence at and participation in this camp, program or activity presents varying degrees of certain risks—some of which are unknown—which may arise from a condition of the premises at which the camp, program or activity is held; from an action of any person in connection with the conduct of any planned or unplanned activity; or from other unforeseen elements. While it is understood that camp programs and activities are fully supervised by qualified staff whose goal it is to make every camp experience as safe as possible, I acknowledge that such known and unknown risks exist, I understand that my child/ward may incur personal injury or property damage while attending this camp, program or activity, and I fully and willingly agree to assume all risks associated with these activities on behalf of my child/ward.

Medical Release
I consent to first aid and emergency medical care for my child/ward and authorize, if necessary, admission to a hospital for treatment of injuries that my child/ward could sustain while participating in this program. I understand that I am responsible for any and all medical expenses that may be incurred by my child/ward, including emergency medical transport, as a result of any accident or illness while participating in the program. I give permission for Lutherhaven Ministries and Emmanuel Lutheran Church to provide transportation or arrange for transportation through Emergency Medical Services, if needed, for my child/ward for medical care.

Publicity Release
I agree to allow the use of my child’s/ward’s photos, quotes and/or likeness’ in brochures, ads, web pages, video tape and other media as deemed useful by the camp for marketing purposes. I waive rights to any royalty or fees that might be applicable for the use of such images, quotes or likeness’.
Child's Name (First and Last Name) *
By typing your name below, I have reviewed and agree to the Permissions & Liability Release.
Parent/Guardian Electronic Signature (First and Last Name) *
Date *
Adult Volunteers Needed
Emmanuel relies on volunteers to make VBS a success. Any amount of your time is greatly appreciated.
Would you like to Volunteer at VBS? *
Adult Volunteer Name(s) & Phone Number
Volunteer needs (check all you are interested in)
THANK YOU for registering and/or volunteering for Emmanuel Lutheran Church's VBS with Lutherhaven Camp Counselors June 20-24, 2022!
If you have a multiple children participating in VBS, each child must have a separate registration form. Thank you.

Phone: (208) 882-3915
Email: youth@elutheran.church 
Website: https://elutheran.church/
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