Olive Online Registration
Olive Community Services Inc. is a non-profit organization that is dedicated to providing programs and services to promote the health and well-being of seniors, their families, and their community.

We are passionate about making a positive difference in the lives of seniors and improving their quality of life. Through our programs and services, we strive to inspire, empower, and motivate our participants to achieve their maximum potential in a supportive and inclusive environment.

We call our seniors OLIVERS. We understand that our Olivers need support and engagement in current times of social distancing due to the COVID-19 outbreak. We have decided to provide programming using technology such as Zoom. We hope to build a virtual community of Olivers across the country and the globe.

Please take a few minutes to fill in important information so we may better serve you.
Full Name *
Age Range *
Date of Birth
Choose one or more races that you consider yourself to be: *
Email *
Street Address *
Apartment Number
City *
State *
Zip code *
Cell Phone number *
Emergency Contact Name
Emergency Contact Number
Emergency Contact relationship
Interests/ Hobbies *
Would be interested in our pen pal Dear Oliver program? *
Are you interested in attending Olive Online classes on Zoom? *
"Olive Friends" is a friendly visitor program that we can now incorporate into a friendly caller program due to the current situation. We can connect you to a fellow Oliver or have our volunteers call you weekly. *
What are your biggest challenges during the COVID-19 crisis? *
Comments and Suggestions
Media Release: I hereby give my permission to Olive Community Services, Inc. to use any photos or videotape material taken of myself during Olive related events and programs. I authorize Olive Community Services, Inc., its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Olive Community Services, Inc. may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. *
Waiver: The information presented during Olive programs is for informational purposes only. You, the participant, are solely responsible for all risks associated during the course of the program. By assuming those risks you are waiving and releasing all claims you may have or may want to assert against Olive Community Services,Inc., all staff and board members. You release Olive Community Services and all other consultants from all claims, damages, demands, rights of action, causes of action and liabilities, injuries, disabilities present or future, known or unknown, anticipated or unanticipated, resulting from or arising out of the programs, facilities and any other suggestions made during Olive (Online and in-person) programs. Please consult a physician before starting any nutrition, supplement, or exercise program. The nutrition, supplement and exercise provided during Olive programs is not intended as a substitute for consulting with your physician. Any attempt to diagnose and treat an illness should be done under the direction of a healthcare professional/physician. The individuals providing you with nutrition and supplement information and exercise during this program are not responsible for any adverse effects, injuries, disabilities or consequences resulting from the use of the suggestions, preparations, or procedures over the course of the program. *
You will be asked to submit a signature on completion of this form. Please follow the instructions provided.
Thank you for registering for Olive Online. You are officially an Oliver now!
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