Such A Time As This Event Student Registration

For Such A Time As This — Student & Leader Registration

A one-day event where we will take a look throughout the Bible to see women God called and used to make a difference in the world around them. As we look at these incredible women, their stories teach us how to trust, lead, pray, fight, rejoice, sacrifice, love, serve, and be the women God has designed us to be. We were created for such a time as this!
For Such A Time As This: Student & Leader Registration
One form per student or leader

Host Sites:

Freedom Church- Tallahassee
August 15, 2026

Wausau Assembly of God
August 22, 2026

Navarre 1st Assembly of God
October 17, 2026

Contact:
Amanda Fussell 334-701-0211
amanda.fussell@westflorida.ag

Event Time: 9:30 AM–3:00 PM

Students: $30 per person; Leaders/Adults: $20 per person.

Lunch will be provided. Event T-shirts are $20 each and must be preordered.
Registration Type:
Participant Full Name

First NameLast Name
Participant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Participant Age
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Participant/Guardian Email Address
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Church Name

Church NameChurch City
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which location
Please select one
Please list any allergies, medications, or medical conditions. Enter “None” if there are none.
Number of Shirts
Event T-Shirt Size
Event shirts cost $20 each and must be preordered.
If you ordered more than one shirt, list the size for each additional shirt.
WAIVER & LIABILITY ASSUMPTIONS

This registration form is for a parent or guardian to complete for a student, or for an adult leader to complete for themselves. Your digital signature is legally binding and gives approval for participation in the For Such A Time As This event hosted by West Florida Ministry Network Student Ministries and the selected host church.

In consideration of the participant’s attendance, the participant and their parent or legal guardian, if applicable, release West Florida Ministry Network Student Ministries, the selected host church, and their officers, directors, employees, agents, and volunteers from any claims, demands, liabilities, losses, damages, costs, and expenses arising out of participation in the event, whether caused by negligence or otherwise.

The participant and parent or legal guardian, if applicable, acknowledge that the event involves risks, including the risk of serious bodily injury, death, and property damage, and assume all such risks.

This release is governed by the laws of the State of Florida and is binding upon the parties and their heirs, successors, and assigns.

Signatures: In witness whereof, the parties have executed this release as of the date signed below on this form.
MEDICAL RELEASE, PERMISSION, & SIGNATURE:
I give permission for hospital or medical center staff to administer any necessary treatment immediately to the participant should they be sick or injured during the For Such A Time As This event. I do not hold West Florida Ministry Network Student Ministries, the selected host church, or their officers and staff responsible for any injury as a result of participation in the event.

Your signature indicates that you understand and support participation in this event and will abide by all rules, guidelines, and medical release requirements. I further give permission for photographs, videotapes, and interviews to be taken during the event and for such media to be used to illustrate, promote, and advertise West Florida Ministry Network Assemblies of God.

The participant remains under the direct supervision of their church leadership and/or parent or guardian.
Please check with your group leader before paying individually.
Parent or Adult Signature
Your registration total will be calculated below.

If your church is paying, please submit this registration and coordinate payment through your group leader.

If you are paying individually, choose I am paying online today to complete payment by credit card.
How will this registration be paid?

Event Registration

Student Registration

$30.00

Leader/Adult Registration

$20.00

Event Shirt

$20.00 Quantity

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Online Payment Amount
Should be Empty:

For Such A Time As This — Student & Leader Registration

Event Registration*

Event Registration