2026 OMP 101 Registration and Release Form

Please note the dates and times for the location you are interested in, and note that in Little Rock we are offering a Morning Session or an Afternoon Session. Please select only 1 session when registering.

July 27-29, Little Rock, Pulaski Heights UMC, Morning 8:00 AM - 12:00 PM

July 27-29, Little Rock, Pulaski Heights UMC, Afternoon 1:00 PM - 5:00 PM

Participant Name

First NameLast Name

Participant Date of Birth

Date

Participant Gender

Participant Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of Participant School

Grade Participant has completed as of June 2026

Participant T-shirt Size

Participant Home Church

Parent/Guardian Name (Primary Emergency Contact)

First NameLast Name

Relationship

Parent/Guardian Cell Phone Number

Area CodePhone Number

Parent/Guardian Email

Parent /Guardian Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Secondary Emergency Contact Name

First NameLast Name

Secondary Emergency Contact Number

Area CodePhone Number

(1) Name of adult who is authorized to pick up the participant (other than the adults listed above).

First NameLast Name

(1) Phone Number of authorized adult to pick up participant.

Area CodePhone Number

(2) Name of adult who is authorized to pick up the participant (other than the adults listed above).

First NameLast Name

(2) Phone Number of authorized adult to pick up participant.

Area CodePhone Number

Please list anyone who is not authorized to pick up the participant.

Does the participant have any food or medical allergies we need to be aware of? Please list any specific allergies.

Is the participant prescribed an inhaler or epi-pen? PLEASE NOTE: Participant must be capable of self-administration of an inhaler or epi-pen.

Does the participant have any present physical, medical, or behavioral conditions we need to be aware of? If yes, please explain. (All disclosures will be handled with confidentiality.)

OMP 101 Mission Selection

Please select only 1 session when registering.

July 27-29, Little Rock Morning, Pulaski Heights UMC, 8:00 AM - 12:00 PM

July 27-29, Little Rock Afternoon, Pulaski Heights UMC, 1:00 PM - 5:00 PM

Little Rock Morning, July 27-29 (8am to 12pm)

Little Rock Afternoon, July 27-29 (1pm to 5pm)

Required

By signing Section D: Terms and Conditions/Permissions/Release I hereby:

1. Medical Treatment. (i) Authorize OMP, its staff and/or volunteers to seek medical treatment for any injury or illness incurred during OMP Event, (ii) grant permission for any physician to examine and treat, hospitalize, or secure treatment in the event of an emergency, and (iii) agree to be solely responsible for the cost of any and all medical treatment (and medication) received by the volunteer.

2. Assumption of Risk. Acknowledge and understand that participation in OMP Event may carry the possibility of physical illness, injury, death and/or property damage, and that I assume the risk of such illness, injury, death and/or property damage by participating in OMP Event.

3. Waiver, Release, Discharge and Hold Harmless. (i) Agree on behalf of myself and my family members to waive, release, discharge and hold harmless OMP and any related agency, conference, district, local church, church member or attendee, employee, volunteer, or agent of OMP, from any and all liability, actions, causes of actions, claims or demands for personal illness or injury, death or property damage of any kind or nature, and any other claims whatsoever arising out of, or in any way connected with my participation in OMP Event, (ii) Understand this waiver, release, discharge and hold harmless shall extend to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown, and (iii) Acknowledge that this waiver, release, discharge and hold harmless shall serve as an assumption of risk, waiver, release, discharge and hold harmless for myself, my family and our heirs, executors, administrators, guardians or anyone else who might assert a claim on me.

4. Use of Image. Consent to OMP staff and/or volunteers taking photographs, movies or videotapes of me for OMP purposes. This consent also includes the right to edit, use and reuse said products for any and all OMP purposes, including but not limited to educational and ministry services, and advertising or marketing efforts, and release any and all rights, title and interest I may have in said photographs, movies, videos, finished pictures, reproductions, copies or negatives of the same in connection with such uses.

5. Dispute Resolution. This Information and Release Form shall be governed by and construed in accordance with the laws of the State of Arkansas exclusively, and any and all claims arising from and/or related to this agreement may only be brought in a state court located in Pulaski County, Arkansas.

SIGNATURE

YOU HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE ANY AND ALL LIABILITY, CLAIMS, AND DEMANDS OF WHATEVER KIND OR NATURE AGAINST THE OZARK MISSION PROJECT AND ITS AFFILIATED PARTNERS AND SPONSORS, INCLUDING IN EACH CASE, WITHOUT LIMITATION, THEIR DIRECTORS, OFFICERS, EMPLOYEES, VOLUNTEERS, AND AGENTS (THE RELEASED PARTIES), EITHER IN LAW OR IN EQUITY, TO THE FULLEST EXTENT PERMISSIBLE BY LAW, INCLUDING BUT NOT LIMITED TO DAMAGES OR LOSSES CAUSED BY THE NEGLIGENCE, FAULT OR CONDUCT OF ANY KIND ON THE PART OF THE RELEASED PARTIES, INCLUDING BUT NOT LIMITED TO DEATH, BODILY INJURY, ILLNESS, ECONOMIC LOSS OR OUT OF POCKET EXPENSES, OR LOSS OR DAMAGE TO PROPERTY, WHICH YOU, YOUR HEIRS, ASSIGNEES, NEXT OF KIN AND/OR LEGALLY APPOINTED OR DESIGNATED REPRESENTATIVES, MAY HAVE OR WHICH MAY HEREINAFTER ACCRUE ON YOUR BEHALF, WHICH ARISE OR MAY HEREAFTER ARISE FROM YOUR PARTICIPATION WITH OR IN AN OZARK MISSION PROJECT EVENT.

By SIGNING here, I give permission for the child named above to participate in all programs and activities of OMP. In consideration for allowing the participation of my child in all programs and activities of OMP, I hereby consent to this form, including any Release of Liability above, on behalf of my child, and agree that this form shall be binding upon my child, me, my family, heirs, legal representatives, successors, and assigns. I represent that I am the parent or legal guardian of the child listed above, who is under 18 years of age. I have read the above form and am fully familiar with the contents thereof.

How did you hear about OMP 101?

Other

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OMP 101 Registration. There are several payment options below. Please choose the one that works best for your family. If you would like a full scholarship to participate in OMP 101 please reach out to janderson@ozarkmissionproject.org.

OMP 101 Registration$100.00

There are several payment options below. Please choose the one that works best for your family. If you would like a full scholarship to participate in OMP 101 please reach out to janderson@ozarkmissionproject.org.

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Questions?

Contact OMP: 501.664.3232 or 479.212.8017.

Email janderson@ozarkmissionproject.org.

OMP 101 Registration and Release Form

Participant Information

Emergency Contact Information

Medical Information and Participation Releases

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