Rooted in Christ

Youth Camp 2021 – Sign Up Form

  • Date Format: DD dash MM dash YYYY
  • (Please note that Empowered Youth Camp information will be sent to this email address)
  • Baptisms : We’re looking forward to witnessing members of our Youth family take the step of water baptism. Baptism is a significant moment in the journey of faith and a public declaration of a commitment to follow Jesus. Baptisms will take place at 1pm Celebration at Empowered Nations Church on Sunday 24 January 2021. This will allow family and friends to share in this special moment. For students wanting to be baptised, a prep-course will be run on Empowered Youth Camp.
    Baptisms will be conducted at 1pm at the campsite on Saturday, 23 January
  • (Parent / Guardian)
  • (Parent / Guardian)
  • Indemnity : By Submitting I hereby absolve Empowered Youth (the youth ministry of Empowered Nations Church), its staff, leaders, volunteers and representatives against any and all claims arising from, or in connection with, any injury, accident, misfortune, damage or loss that may occur to my child and or their property, equipment or personal effects while present at Empowered Youth Camp, including any injury that my child may cause to any other person.

    Medical Treatment Consent : I hereby give permission for Empowered Nations Church, its staff, leaders, volunteers and representatives to obtain emergency medical, hospital or ambulance assistance at any time they consider necessary. I understand that every reasonable effort will be made for the emergency contact listed above to be notified prior to instituting such procedures. I acknowledge that I will be liable for any and all medical, hospital and ambulance costs and expenses incurred in my child’s treatment.
    Smoke, Drug and Alcohol - Free Event : I understand that Empowered Youth Camp is smoke, drug and alcohol free, and understand that my child may be removed from the premises, should they be found to be in possession of, consuming or under the influence of such substances.
    Media Waiver : I acknowledge that Empowered Youth Camp will be captured in photographs, video and audio. Empowered Youth reserves all rights to use such material for promotional purposes. I understand that it is a condition of my child participating in Empowered YouthCamp that all claims are waived in relation to inclusion of their likeness in such films or recordings. I give my consent for my child to be captured on photographic, video and audio media, unless specifically requested in additional notes below.
    Contact Information : I allow my child to be contacted by Empowered Youth staff and relevant volunteer leaders for the purpose of connection and notification of upcoming youth connect groups, gatherings, and events. I understand that the contact details I provide will be stored on a database at Empowered Nations Church. I am able to change my permission at any time by contacting an Empowered Nations Church staff member. No student will be contacted directly without prior permission and consent from the parent/guardian/emergency contact listed above.
    Acknowledgement and Parental Permission Slip :

    By submitting this form, I give permission of my child to attend Empowered Youth Camp 2021. I acknowledge that in giving permission for my child to attend Empowered Youth Camp, I am doing so at my own risk. I understand that although Empowered Nations Church and its staff, leaders, volunteersand representatives will exercise all reasonable care in the conduct and supervision of this event, Empowered Nations Church and its staff, leaders, volunteersand representatives deny all liability for any injury sustained by participants during the course of the youth camp. I hereby absolve Empowered Nations Church, its staff, leaders, volunteers and representatives from any and all liability.