Rise Camp Registration Form 2025

Rise Camp Registration Form 2025

Thank you for your interest in Rise Camp 2025!
We are so excited to be heading to our first ever Rise Camp!

Rise Camp is for students in 6th-12th grade for the 2024/2025 school year and will include four days of adventure, games, worship, and biblical teaching that is all tailored specifically for your student!

Our goal is to help break down walls by getting students out of their normal environment in order to help them form deeper relationships with God. Oh... and to have a ton of fun while we're doing it!

Camp dates: June 25th-28th, 2025

Location: Lake Williamson Christian Retreat Center

What the registration fee covers:
- Admission to Lake Williamson
- Lodging
- 9 meals (Dinner on 06/25 through Lunch on 06/28)
- Transportation to and from camp
More information and updates will be sent out as we get closer to Camp.

If you have any issues with the registration process or further questions, please contact:

Dixon Jernigan, NextGen Pastor

Cell: (757) 503-8729

Email: dixon@onelifehenderson.com
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Student Registration
$309.00 Quantity
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Student Information
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade During 2024/2025 School Year*
Gender*

MaleFemale
Please provide any medical or dietary restrictions you have
Student #2
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade During 2024/2025 School Year*
Gender*

MaleFemale
Please provide any medical or dietary restrictions you have
Student #3
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade During 2024/2025 School Year*
Gender*

MaleFemale
Please provide any medical or dietary restrictions you have
Student #4
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade During 2024/2025 School Year*
Gender*

MaleFemale
Please provide any medical or dietary restrictions you have

Family Information
Parent/Guardian's Name*

First NameLast Name
Contact Phone Number*
E-mail Address*
example@example.com
Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Information

Parent/Guardian will be contacted first. Please list an additional emergency contact in the unlikely event that the Parent/Guardian is not available.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Relationship to Student*

Liability
I hereby give my permission for my students(s) to participate in the One Life Henderson Rise Camp 2025.

I understand that participation in any program which involves physical activity exposes the camper to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect the camper from all conceivable dangers.

I hereby affirm that my student(s) has/have no conditions that would make it unsafe for him/her/them to participate in the camp.

I understand that One Life Henderson may exclude my student(s) from Summer Camp in the event that I or my student(s) fail to abide by One Life Henderson's health and safety protocols, disrupt, impede or interfere with the operations of the Summer Camp, or threaten the health, safety or welfare of other participants, volunteers, or staff and that no refund of any fees will be made in such circumstances.
I accept.
Medical Release
I understand that One Life Henderson will make every effort to contact me in the case of an emergency. I give my permission for One Life Henderson to administer any medications needed and to provide and arrange for and consent to any necessary medical treatment for my student(s) while at the School, including onsite and offsite emergency care. I accept responsibility for the costs of all such medical treatment.
I accept.
Photography Release
In consideration of student(s) participation at the camp, and without any further consideration from One Life Henderson, I hereby grant permission to One Life Henderson, staff and affiliates to utilize my student(s)’s appearance, performance or voice in any and all manner and media throughout the world for the purpose of promotion, reporting or publication.
I accept.
By signing this Waiver and Release of Liability, with full appreciation of the risk involved, on my own behalf and on behalf of my student(s), I hereby voluntarily release and forever discharge One Life Henderson, its trustees, officers, employees, agents, insurers and contractors from any and all legal or financial responsibility for any personal injury, disability, illness, damage, medical expense or death, arising from or related to my student(s)’s participation in Summer Camp. I agree, for myself and my student(s), not to make any type of legal or equitable claim on One Life Henderson, or any of its trustees, officers, employees, agents, insurers or contractors with respect to any injury I or my student(s) may suffer, whether or not it arises through the negligence, omission, default or other action of anyone affiliated with One Life Henderson, including other campers. I further agree that if any such claim is made, I will indemnify and defend One Life Henderson with respect to any such claim, injury or damage.
I accept.
Signature*

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Rise Camp Registration Form 2025

Student Information

Student #2

Student #3

Student #4

Family Information

Emergency Contact Information

Liability

Medical Release

Photography Release

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