2025 - 2026 Salt House Families Registration Form

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This form registers one child/youth for Salt House Family Programming from Fall 2025 through Summer 2026. Please register all Salt House members ages 0-18. Fill out a separate form for each child/youth in your family.

Email *

Your Name (First & Last) *

Name of Child or Youth (First & Last) *

Birthday *

YYYY

Preferred Pronouns *

Grade *

Other Info (Child's personality traits or special needs that may help us work more effectively with your child.)

PHOTO RELEASE: I give permission to Salt House to use photographs and videos of my child in public display, media release, and social media. I understand these photographs will NOT be sold or used for commercial purposes. *

Yes

MEDICAL RELEASE: If I cannot be reached, I give my permission and consent for staff to call for medical assistance and/or transport my child to a local medical facility and seek treatment while in Salt House care. *

Yes

YOUTH PROGRAMMING RELEASE: In addition to regular youth programming, I give permission for my child to participate in these activities which will be led by Safe Haven trained adults. Please select all that apply. *

Activities outside the church, such as bowling, confetti events, or a campout.

May ride with a Safe Haven trained adult to youth events

My youth may send and receive texts with Safe Haven trained leaders about Salt House events. (not required, but available if youth wants this line of communication)

My child is not in middle school or high school, so this release does not apply to them

Required

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