Child's Information

First Name: Last:

Age:

Birthday:

Grade Entering in Fall:

Allergies we should be aware of (i.e. food):

Parent's Information

Mother First Name: Last:

Father First Name:  Last:

Home Address

City State Zip

Phone:

Email Address:

Emergency Contact (if other than parents)

First Name: Last:

Phone:

To get the most out of Kidz Klub we encourage you to buy the Hands-On Bible. The cost is $12 for the first Bible and $10 for each additional Bible. If you are interested in the Hands-On Bible please enter the amount you wish to purchase in the box below. Bibles can be paid for and picked up at any Kidz Klub gathering.

Number of Hands-On Bibles:

Policy statement

Mt Olive gladly offers youth programs to all children for free in recognition & thanksgiving of the Gospel which is to be freely available to all.

We the undersigned have legal custody of the minor named above and have given our consent for him/her to attend Mt. Olive's Kidz Klub. We understand that there are inherent risks involved in any ministry event, and we hereby release the Church, its pastors, employees, agents and volunteer workers from any and all liability for any injury, loss or damage to person or property that may occur during the course of our child's involvement. In the event that he/she in injured and requires the attention of a doctor, we acknowledge the consent given in Kidz Klub / G.O.T.H. registration from. We also acknowledge that we will be ultimately responsible for the cost of any medial care should it not be reimbursed by the minor's health insurance provider.
By submitting this form you are agreeing to give Mt. Olive Church the permission to take pictures of your child for the purpose of in church promotion (i.e. slide show).