Salt City Registration

Gathering Thursdays from 6-7:30pm September 4th- April 9th!
Registration ($40 per child) is now open through August 4th and includes all supplies for each child for the year!
We'll gather September 4th-December 18th* (No Salt City September 25th or November 27th) & January 8th-April 9th* (No Salt City April 2nd)
*Note our Christmas Party and End of Year Celebration on these dates!

Please bring or mail check to Olivet Bible Church at 206 N. John St. Kimberly (Memo: Salt City Registration) or bring payment in cash or check by August 18th!

Parent/Guardian Information

* Indicates required field

Primary Parent/Guardian Name *

First

Last

Primary Phone Number *

Email *

In case of weather cancellations or last minute reminders, can you include you on our group text? *

Absolutely! No, thank you!

Secondary Parent/Guardian Name *

First

Last

Secondary Email *

Secondary Phone Number *

Include this number on weather cancellations and last minute reminders too? *

Yes, please! No, thank you!

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please list any Alternate Pick Up Information and/or another other Emergency Contacts you would like us to be aware of. (Name, Relationship to child, Phone Number) *

Child Registration

Child 1 Full Name *

First

Last

Birthday (mm/dd/yyyy) *

Is there any medical or allergy information we should be aware of for your child? *

Age as of September 4th *

Child 2 Full Name *

First

Last

Is there any medical or allergy information we should be aware of for your child? *

Birthday (mm/dd/yyyy) *

Age as of September 4th *

Child 3 Full Name *

First

Last

Birthday (mm/dd/yyyy) *

Is there any medical or allergy information we should be aware of for your child? *

Age as of September 4th *

Child 4 Full Name *

First

Last

Birthday (mm/dd/yyyy) *

Is there any medical or allergy information we should be aware of for your child? *

Age as of September 4th *

LiABILITY, Medical, and Photo Release WAIVER

Every activity in the Olivet Bible Church (OBC) is carefully planned and supervised. However, even with the best planning and precaution, unforeseen events and injuries can occur. By registering in the OBC Salt City Midweek Program, I agree to assume and accept all risks and hazards inherent in Salt City Midweek activities at OBC.

I acknowledge that involvement of my child(ren) in the event may involve risk of property damage and of personal injury, illness or even death, including but not limited to the risks arising from recreational activities, accidents in and around facilities, adverse weather conditions, and injuries and illness as a result of food-borne illnesses and allergic reactions. I waive and release all rights and claims against Olivet Bible Church, including all leaders, staff and volunteers. By signing this Parental Consent and Release of Liability, I state that my child(ren) is fully capable of safely participating in all event activities, and I expressly assume all risks of my child(ren)’s involvement. In case of a medical emergency, I give permission to the hospital/physician selected by those in charge to secure proper treatment for my child(ren) at parent's expense.

I also consent to the public use of any photos and/or video used for minimal use on behalf of Olivet Bible Church. I understand that church events are photographed/recorded for end-of-year videos, occasional social media posts, & website updates. I hereby grant permission to OBC Salt City Midweek to use photos/videos of my child(ren) for these purposes.

Initial Below to Consent *

Make sure to bring or mail check to Olivet Bible Church at 206 N. John St. Kimberly (Memo: Salt City Registration) or bring payment in cash or check by August 18th!

IF YOU HAVE ANY OTHER QUESTIONS, OR ARE IN NEED OF A SCHOLARSHIPS OR INTERESTED IN OFFERING A SCHOLARSHIP TO ANOTHER CHILD, PLEASE EMAIL KAYLA BELCHER AT [email protected].

Ready to Submit! Let's Go Salt the Earth!

*If you are registering more than 4 children, please fill out and submit another form!

"Walk in wisdom toward outsiders, making the most of the time. Your speech should always be gracious, seasoned with salt, so that you may know how you should answer each person." | Colossians 4:5-6

​Parent/Guardian Information

Child Registration

LiABILITY, Medical, and Photo Release WAIVER

Make sure to bring or mail check to Olivet Bible Church at 206 N. John St. Kimberly (Memo: Salt City Registration) or bring payment in cash or check by August 18th!

Parent/Guardian Information