Registration Options

  • Ages 6 to 12 years old

  • Ages 13 to 17 years old - "Counselor In Training" (CIT)

  • NO camp shirt; Ages 18+ years old

  • Camp shirt included; Ages 18+ years old



Attendee Info



Medical Information

  • If yes, attach a doctor’s note outlining signs, symptoms, and emergency steps to the EpiPen with a rubber band.



Parent/Guardian Info



Emergency Contact Info

1. In consideration for receiving permission to participate in the Powerhouse International Kidz Conference, I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Family Worship Center Church, Jimmy Swaggart Ministries, Crossfire Youth Ministries, the Board of Trustees, their officers, agents, or employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in such activity, while in, on or upon the premises where the activities are being conducted, REGARDLESS OF WHETHER SUCH LOSS IS CAUSED BY THE NEGLIGENCE OF THE RELEASEES, or otherwise and regardless of whether such liability arises in tort, contract, strict liability, or otherwise, to the fullest extent allowed by law.

2. I am fully aware of the risks and hazards connected with the activities of Crossfire International Youth Conference, and I am aware that such activities include the risk of injury and even death, and I hereby elect to voluntarily participate in said activities, knowing that the activities may be hazardous to my property and me. I understand that RELEASES does not require me to participate in this activity. I voluntarily assume
full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of being engaged in such an activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent allowed by law.

3. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage, or costs, including court costs and attorneys’ fees that Releases may incur due to my participation in said activities, WHETHER CAUSED BY NEGLIGENCE OF RELEASEES or otherwise, to the fullest extent allowed by law.

4. It is my express intent that this Waiver and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the above-named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Louisiana and that any mediation, suit, or other proceeding must be filed or entered into only in Louisiana and the federal or state courts of Louisiana. Any portion of this document deemed unlawful or unenforceable is severable and shall be stricken without any effect on the enforceability of the remaining provisions.

IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Wavier of
Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this agreement for full, adequate and complete consideration fully intending to be bound by same.

Photo/Video Release For For Minors under 18 years old
As the parent or legal guardian I grant Jimmy Swaggart Ministries my permission to use my child’s photograph(s) and video(s) publically for any legal use, including but not limited to marketing materials published by Jimmy Swaggart Ministries. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

I hereby release and hold harmless Jimmy Swaggart Ministries from any reasonable expectation of privacy or confidentiality associated with the images specified.

I hereby release the Jimmy Swaggart Ministries, its contractors, its employees and any third parties involved in the creation or publication of marketing materials, from liabilities for any claims by me or any third party in connection with my child’s participation.



$0.00
$0.00



Billing Information

  • Visa
  • Mastercard
  • American Express
  • Discover
RegFox Event Registration Software