Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Application for Bicycle Helmet

  1. Terms of agreement*

    I agree to receive a bicycle helmet for my child. I will hold the Silverton Police Department, the City of Silverton and its representatives harmless from any and all claims of injury or damage from wearing of the bicycle helmet. I will direct all inquiries regarding equipment, warranty or service to the manufacturer or its authorized representative.

  2. Parent signature


  3. Print name


  4. For office use only

    I gave the above named individual a bicycle helmet for their child to wear. I explained that the helmet must be worn when on a bicycle, skateboard, scooter, roller blades/ skates or anything that moves faster than a person can walk.

  5. Silverton Police Representative


  6. Leave This Blank: