2026 Canoe Action Camp Form

2026 Canoe Action Camp (CAC) Form (August 28-30)

Registration Deadline: August 28, 2026 This form is for both students and leaders to use for registration purposes. One registration form per person is required.
When: August 28-30

Where: Econfina Creek, Panama City, FL

Cost $85
Who are you registering?
Name

First NameLast Name
Gender at Birth
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Registrants Email
example@example.com
Registrants Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
- Church Name
- Church City
- Outpost Coordinator/Leader Name:
- OutpostCoordinator/Leader Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- OutpostCoordinator/Leader Email (needed for confirmation)
  example@example.com
- Parent/Guardian Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Emergency Contact Name
  
  First NameLast Name
- Relationship
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Is the registrant's mom or dad a credentialed minister or missionary with the Assemblies of God?
- If moving up to buckskin or wilderness select yes, if not select no:( If yes bring paperwork and Application )
- Allergies or Medical Conditions
- While at the even, will the student be taking any medications?
- Medications he/she will be bringing to the event
- Child is free from contagious health problems
- Plese list any special dietary instructions:
- List any activities your child is NOT permitted to participate in:
- I give permission for qualified medical personnel, including hospital or medical center staff, to administer any necessary medical treatment to my child in the event of illness or injury during the 2026 CAC. I understand that every reasonable effort will be made to contact the parent/guardian (if applicable) prior to treatment, or as soon as possible thereafter.
  
  I hereby release and hold harmless the West Florida Ministry Network Student Ministries Department, its officers, employees, volunteers, agents, and representatives from any and all liability, claims, or demands for personal injury, illness, or property damage that may arise from my participation in this event, except in cases of gross negligence or willful misconduct.
  
  I also understand that photos, audio recordings, and video footage may be taken during the 2026 CAC, and I grant permission to the West Florida Ministry Network Student Ministries Department to use, reproduce, publish, or distribute such media that includes my childs image(s), likeness, or voice in promotional materials, printed publications, social media, or other ministry-related communications, without expectation of compensation. I waive any rights of ownership or approval and release the West Florida Ministry Network and its representatives from any claims related to the use of this media, provided it is used in a manner consistent with Christian ethics and ministry promotion.
  
  Your signature indicates that you understand and support your child’s involvement in CAC and will abide by all rules, guidelines, and medical release.
  
  I/We also acknowledge that participation in all event-related activities necessarily involves risk of physical injury.
  
  I/We also acknowledge that my child is under the direct supervision of the church leadership they are attending with.
- Required Checkboxes
- Today's Date:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- By signing below, I confirm that I am the parent or legal guardian of the student named in this registration and that I agree to the terms and releases above.
- Does your church have a current background check (within last 2 years) that allows you to be around minors? (Please note your pastor will be pastor will be contacted in reference to this.)
- Name of Emergency Contact
- Emergency Contact Relationship (Spouse, Friend, Pastor)
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- I acknowledge that participation in the 2026 CAC involves physical activities and travel, and I agree to conduct myself in a manner consistent with Christian character and event guidelines. I understand that qualified medical personnel may administer necessary treatment to me in the event of illness or injury, and I hereby release and hold harmless the West Florida Ministry Network Student Ministries Department, its officers, employees, volunteers, agents, and representatives from any liability, claims, or demands for personal injury, illness, property damage, or loss that may arise from my participation in this event, except in cases of gross negligence or willful misconduct.
- I have read and agree to the Leader Participation & Liability Release stated above.
- If you would like to pay by check or cash at the event or through your church, please enter "Check" in the coupon code below to zero out your amount owed below.
  
  OR use the payment system below to pay for your registration.
  
  For any questions, please call JR Bolden (205) 261-2670 or email royalrangercordinator89@gmail.com
- Leader Signature of Consent By signing below, I confirm that I have read and agree to the terms and releases above and am voluntarily participating in the 2026 West Florida CAC.
- Should be Empty:

2026 Canoe Action Camp (CAC) Form (August 28-30)