• Adult leaders that currently work in the Girls Ministries Program at your church and your church is chartered with the Alabama Ministry Network of A/G

  • Students 6-18 or Teen volunteers

  • Adults 18 or older

*Deposits are non-refundable.


Student Information


Volunteer Personnel/GM Sponsor Information


Church Information


Mpact/TGM Student Information

  • Girls in Kindergarten (Age 5)

  • Girls in Grades 1-2

  • Girls in Grades 3-4-5

  • Girls in Grades 7-8

  • Girls in High School




Preorder T-Shirts and Cups

  • $12 if pre-ordered, $15 if purchased at Camp


  • $15 (free refills at camp)


Parent Information


  • A security check must be completed on each adult leader 18 years or older at the end of this registration. Without the security check, your registration will NOT be processed.

  • I currently hold active A/G ministerial credentials and am in good standing with the Assemblies of God.

  • I have already had a background check with the Alabama A/G for another event this year.












Emergency Contact Information


Student / Teen Volunteer Release Forms

We, the parents/legal guardians authorize the Springville Camp and Conference Center, the Alabama Ministry Network of the Assemblies of God, and their officers, directors, employees, volunteers, and agents to have access to all registration and medical information given on this application to be used in the treatment/care of the registrant while they are attending the event applied for.

We, THE PARENTSAND/OR LEGAL GUARDIANS OF participant, understand that we will be notified in the case of a medical emergency involving the Participant. However, in the event that we, or either of us, cannot be reached, we authorize the calling of a doctor and the providing of necessary medical services in the event the Participant is injured or becomes ill. We authorize any or more of the following persons to make emergency medical care decisions on behalf of the Participant, if required by law or a health care provider: Alabama Ministry Network of the Assemblies of God, or any of its agents, employees, or volunteers.
We, the parents and /or legal guardians of Participant, understand that Springville Camp and Conference Center, Alabama Assemblies of God Kids Camp, or the Alabama Ministry Network of the Assemblies of God, or any of its agents, employees, or volunteers, shall not be responsible for medical expenses incurred based on the authorization. We hereby agree to hold harmless, defend and indemnify Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center, the Alabama Ministry Network, its parents, subsidiaries and affiliates, board members, officers, employees, agents, and volunteers from all obligations, damages, losses, attorney‘s fees, defense costs, demands, investigations, actions, liabilities, claims, cross-actions, third-party actions, causes of action, of any kind or nature whatsoever, including the negligence or gross negligence of Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center, or the Alabama Ministry Network of the Assemblies of God (collectively claims) that may be asserted by anyone and that has any relation to the Participant. It is our express intention to defend, indemnify and hold harmless Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center and the Alabama Ministry Network of the Assemblies of God from all claims arising out of or resulting from or in any manner relating to the treatment, medical or otherwise, of Participant. We agree to notify Alabama Assemblies of God Kids Camp in the event of any health changes which would restrict the Participant’s participation in any activities. We also understand that Alabama Assemblies of God Kids Camp representative (s) reserve the right to restrict the Participant from any activity for any reason.

In consideration of my child’s participation in the activities listed below on the date above and at location named below (herein the activity):
We, being the parents or legal guardians of the child named above, do hereby consent to the participation of the activities of the Alabama Assemblies of God Kids Camp located at 3886 Mt. View Rd., Odenville, AL. 35120. Activities include outdoor activities in which the participants may be subject to bites from insects, mosquitoes, ticks, spiders, and or snakes. Activities include rock wall climbing, basketball, volleyball, swimming in pool, canoeing, paddle boats, water inflatables which include the blob, jungle joe, water trampoline, aqua glide, rocket, log roll, and wet willie (water slide) , zip-line into lake, (life jackets required for all lake activities and certified lifeguards always on duty) zip line across lake, recreational games (relay race style, tug of war, slip n’ slide, etc.) which may include water and mud. We hereby represent that Participant is in good health and in proper physical condition to participate in the above-referenced activities. Further, we certify that Participant is physically able and adequately trained to participate in such events, specifically swimming. we hereby understand and acknowledge the physical rigors associated with the above-referenced activities and understand that participation involves risks and dangers which include, without limitation, serious bodily injury, permanent disability, paralysis, death, inaccessibility of medical care, dangers arising from adverse weather conditions, inadequate safety measures, participants of varying skill levels, situations beyond the immediate control of The Alabama Assemblies of God Kids Camp, other undefined harm or damage which may not be readily foreseeable, and other presently unknown risks and dangers (collectively the “Risks”). We understand these Risks may be caused in whole or in part by Participant’s own actions or in actions, the actions or inactions of others participating in the activities, and knowing such, we hereby expressively authorize and give permission for Participant to participate in all the above-referenced activities.

We, being the parents/legal guardians of child participant agree, to assume all the risks and responsibilities, known and unknown, surrounding child’s participation in the activity. To the maximum extent allowed by law, we release, hold harmless, and agree to indemnify Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center and the Alabama Ministry Network of the Assemblies of God, and their officers, directors, employees, volunteers, and agents from and against any present or future claims, losses, liabilities, costs, and expenses for injury to person or property, or for any other damage, which we or participant may suffer, or for which we or participant may be liable to any other person, related to the participant’s participating in the activity ( including periods in transit to or from destinations), resulting from any cause, including but not limited to negligence on participants part or on the part of any of the released parties; provided that this release of liability shall not apply to gross negligence or willful or wanton misconduct. We hereby warrant that we have read this Agreement carefully, understand its terms and conditions, acknowledge that we are giving up substantial legal rights by signing it, we acknowledge we have signed this Agreement freely and voluntarily, without any inducement, assurance, or guarantee. This Agreement represents the complete and entire understanding between the parties regarding these issues and no oral representations, statements or inducements have been made apart from this Agreement. If any provision of this Agreement is held to be unlawful, void or for any reason unenforceable, then that provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any remaining provisions. We expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal, valid, and binding obligation upon me enforceable against me in accordance with its terms. We expressly agree that this assumption of risk, release, and indemnity Agreement is intended to be as broad and inclusive as permitted by law. I further state that WE HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS, AND WE VOLUNTARILY SIGN THIS AGREEMENT AS OUR OWN FREE ACT. We understand and agree that no oral or written representations can or will alter the contents of this document. We agree that this Agreement shall be governed by the laws of the State of Alabama, which shall be the forum for any lawsuits filed under or incident to this Agreement or the above-described activities. A photocopy or facsimile of this authorization shall be as valid as the original.

In consideration of the named minor’s participation in this event, I, the undersigned parent/legal guardian of the named minor, agree to indemnify and hold harmless Releasees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to the named minor’s participation in this event.

I hereby certify on behalf of myself and the named minor that I have full knowledge of the nature and extent of the risks inherent in participation in this event and that I, on behalf of myself and the named minor, am voluntarily assuming said risks. I understand that I and the named minor will be solely responsible for any loss or damage, including personal injury, property damage, or death, the named minor sustains while participating in this event and that by signing this agreement I, on behalf of myself and the named minor, HEREBY RELEASE Releasees of all liability for such loss, damage, or death. I further certify that the named minor is in good health and has no conditions or impairments which would preclude his/her safe participation in this event.

Coronavirus, Covid-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a mean to prevent the spread of the virus. Covid-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Alabama Ministry Network programs or accessing the Alabama Ministry Network of the Assemblies of God facilities could increase the risk of contracting Covid-19. The Alabama Ministry Network of the Assemblies of God in no way warrants that Covid-19 infection will not occur through participation in Alabama Ministry Network of the Assemblies programs of accessing Alabama Ministry Network of the Assemblies of God facilities.

We, Participant’s parents and/or legal guardians, hereby grant Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center, and the Alabama Ministry Network of the Assemblies of God permission to the rights of Participant’s image, likeness, and sound of Participant’s voice as recorded on audio or video tape without payment or any other consideration. We understand that Participant’s image may be edited, copied, exhibited, published, or distributed and we hereby waive the right to inspect or approve the finished product wherein Participant’s likeness appears. Additionally, we waive any right to royalties or other compensation arising or related to the use of Participant’s image or recording.
We agree that Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center and The Alabama Ministry Network of the Assemblies of God may use such images of Participant with or without Participant’s name and for any lawful purpose, including for such purposes as publicity, illustration, advertising, and web content.
We understand there is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be used and/or distributed.
We, the parents and/or legal guardian acknowledge that we have completely read and fully understand this release and agree to be bound thereby. It is our express intention to defend, indemnify and hold harmless Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center, and the Alabama Ministry Network of the Assemblies of God from all claims arising out of Participant’s image, likeness, sound.

We, the parents/and or legal guardians of said participant understand and have discussed with participant that they will abide by the CDC, ADPH, and local guidelines that are put in place during this event.


Volunteer Personnel Release Forms

I authorize the Springville Camp and Conference Center, the Alabama Ministry Network of the Assemblies of God, and their officers, directors, employees, volunteers, and agents to have access to all registration and medical information given on this application to be used in the treatment/care of myself while I am attending the event applied for.

I, for myself, and on behalf of my spouse, children, parents, guardians, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors, and assigns, hereby agree to and make the following contractual representations: I, the Participant understand and authorize the calling of a doctor and the providing of necessary medical services in the event I, the Participant is injured or becomes ill. I do authorize any or more of the following persons to administer medications or treatment needed, and/or to make emergency medical care decisions on behalf of me, the Participant, if required by law or a health care provider. I, the Participant, understand that Springville Camp and Conference Center, Alabama Assemblies of Kids Camp, or the Alabama Ministry Network of the Assemblies of God, or any of its agents, employees, or volunteers, shall not be responsible for medical expenses incurred on the basis of authorization. I hereby agree to hold harmless, defend and indemnify Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center, the Alabama Ministry Network of the Assemblies of God, its parents, subsidiaries and affiliates, board members, officers, employees, agents, and volunteers from all obligations, damages, losses, attorney‘s fees, defense costs, demands, investigations, actions, liabilities, claims, cross-actions, third-party actions, causes of action, of any kind or nature whatsoever, including the negligence or gross negligence of Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center, or the Alabama Ministry Network of the Assemblies of God (collectively claims) that may be asserted by anyone and that has any relation to the Participant. It is my express intention to defend, indemnify and hold harmless Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center and the Alabama Ministry Network of the Assemblies of God from all claims arising out of or resulting from or in any manner relating to the treatment, medical or otherwise, of Participant. I agree to notify Alabama Assemblies of God Kids Camp in the event of any health changes which would restrict me, the Participant’s participation in any activities. I also understand that Alabama Assemblies of God Kids Camp representative (s) reserve the right to restrict me, the Participant from any activity for any reason.

In consideration of the participation in the activities listed below on the date above and at location named below (herein the activity): I, for myself, and on behalf of my spouse, children, parents, guardians, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors and assigns, hereby agree to and make the following contractual representations: I hereby represent that : (i) I am in good health and in proper physical condition to participate in the Activity, and (ii) I am not under the influence of any drugs, prescription or otherwise, which would in any way impair my ability to safely participate in the Activity. I agree that it is my sole responsibility to determine whether I am sufficiently fit and healthy enough to participate in the Activity. I understand and acknowledge the physical rigors associated with the Activity and I understand that participation in the Activity involves risks and dangers which include outdoor activities in which the participant may be subject to bites from insects, mosquitoes, ticks, spiders, and or snakes. Activities include rock wall climbing, basketball, volleyball, swimming in pool, canoeing, paddle boats, water inflatables which include the blob, jungle joe, water trampoline, aqua glide, rock-it, log roll, and wet willie (water slide) , zip-line into lake, (life jackets required for all lake activities and certified lifeguards always on duty) zip line across lake, recreational games (relay race style, tug of war, slip n’ slide, etc.) which may include water and mud. I hereby represent that Participant is in good health and in proper physical condition to participate in the above-referenced activities. Further, I certify that Participant is physically able and adequately trained to participate in such events, specifically swimming, without limitation, and understand that there is risk and danger for serious bodily injury, permanent disability, paralysis, death, inaccessibility of medical care, dangers arising from adverse weather conditions, inadequate safety measures, participants of varying skill levels, situations beyond the immediate control of Alabama Assemblies of God Kids Camp, other undefined harm or damage which may not be readily foreseeable, and other presently unknown risks and dangers (collectively the “Risks”). I understand these Risks may be caused in whole or in part by Participant’s own actions or in actions, the actions or inactions of others participating in the Activity, and I hereby expressively assume all Risks and responsibility for any damages, liabilities, losses, or expenses which I incur as a result of my participation in the Activity. I also accept sole responsibility for my own conduct and actions while participating in the Activity, and the condition and adequacy of my equipment. I understand and agree that if, during my participation in the Activity, Alabama Assemblies of God Kids Camp becomes aware of any serious health issues, injuries, or any other situation that raises significant health or safety concerns, those in charge have my permission to contact my provided “emergency contact”.

Knowing the risks described above, I agree, on behalf of my family, heirs, and personal representatives to assume all the risks and responsibilities, known and unknown, surrounding my participation in the activity, to the maximum extent allowed by law, I release, hold harmless, and agree to indemnify Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center and the Alabama Ministry Network of the Assemblies of God, and their officers, directors, employees, volunteers, and agents from and against any present or future claims, losses, liabilities, costs, and expenses for injury to person or property, or for any other damage, which I may suffer, or for which I may be liable to any other person, related to my participating in the activity (including periods in transit to or from my destinations), resulting from any cause, including but not limited to negligence on my part or on the part of any of the released parties; provided that this release of liability shall not apply to gross negligence or willful or wanton misconduct. I hereby warrant that I have read this Agreement carefully, understand its terms and conditions, acknowledge I am giving up substantial legal rights by signing it, (including the rights of my spouse, children, guardians, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors and assigns), acknowledge I have signed this Agreement freely and voluntarily, without any inducement, assurance, or guarantee. This Agreement represents the complete and entire understanding between the parties regarding these issues and no oral representations, statements, or inducements have been made apart from this Agreement. If any provision of this Agreement is held to be unlawful, void, or for any reason unenforceable, then that provision shall be deemed severable from this Agreement and shall not affect the validity and enforceability of any remaining provisions. I expressly waive any defense to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this commitment constitutes a legal, valid, and binding obligation upon me enforceable against me in accordance with its terms. I expressly agree that this assumption of risk, release, and indemnity Agreement is intended to be as broad and inclusive as permitted by law. I further state that I have carefully read this agreement and understand its contents, and we voluntarily sign this agreement as my own free act.
I certify that I am age 18 or older. I understand and agree that no oral or written representations can or will alter the contents of this document. I agree that this agreement shall be governed by the laws of State of Alabama, which shall be the forum for any lawsuits filed under or incident to this Agreement or the above-described activities.

In consideration of my participation in this event, I agree to INDEMIFY AND HOLD HARMLESS Releasees from all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to my participation in this event.

I hereby certify that I have full knowledge of the nature and extent of the risks inherent in this event participation and that I, on behalf of myself am voluntarily assuming said risks. I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, or death, I sustain while participating in this event and that by signing this agreement I HEREBY RELEASE Releasees of all liability for such loss, damage, or death. I further certify I am in good health and have no conditions or impairments which would preclude my participation in this event.

Coronavirus, Covid-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend social distancing as a mean to prevent the spread of the virus. Covid-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in Alabama Ministry Network programs or accessing the Alabama Ministry Network of the Assemblies of God facilities could increase the risk of contracting Covid-19. The Alabama Ministry Network of the Assemblies of God in no way warrants that Covid-19 infection will not occur through participation in Alabama Ministry Network of the Assemblies programs of accessing Alabama Ministry Network of the Assemblies of God facilities.

I, the Participant, hereby grant Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center, and the Alabama Ministry Network of The Assemblies of God permission to the rights of Participant’s image, likeness, and sound of Participant’s voice as recorded on audio or video tape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published, or distributed and we hereby waive the right to inspect or approve the finished product wherein I, the Participant’s likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of Participant’s image or recording. I, the Participant, agree that Alabama Assemblies of Kids Camp, Springville Camp and Conference Center and the Alabama Ministry Network of the Assemblies of God may use such images of me with or without my name and for any lawful purpose, including for such purposes as publicly, illustration, advertising, and web content. I, the Participant, understand there is no time limit on the validity of the release nor is there any geographic limitation on where these materials may be used and or distributed. I, the Participant, have completely read and fully understand this release and agree to be bound thereby. It is my express intention to defend, indemnify and hold harmless Alabama Assemblies of God Kids Camp, Springville Camp and Conference Center, and the Alabama Ministry Network of the Assemblies of God from all claims arising out of my image, likeness, sound.

I, the participant, understand and will abide by the CDC, ADPH and local guidelines that are put in place at the time of this event.


Health History & Medical Treatment Authorization


  • If an Inhaler is necessary please comment below.

  • If an Epi Pen is necessary please comment below.

  • If an Epi Pen is necessary please comment below.

  • If an Epi Pen is necessary please comment below.

  • If an Epi Pen is necessary please comment below.






Physician & Insurance Information

  • Please list provider and policy number below.

  • Insurance is required for all Participants attending camp. If you do not have current health insurance - it will be provided to you for $25 per person.


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