Winter Blitz 2026 Registration Form

Winter Blitz 2026 Registration Form

Registration Deadline: January 23, 2026 This form is for both students and leaders to use for registration purposes. One registration form per person is required.
Event Location: First Assembly of God, Panama City

1701 N East Ave., Panama City, FL

Event Check-in: 9:30am - 10:00am

Opening Service: 10:00am - 11:30am

Lunch/Free Time: 11:30am - 12:30pm

Fun Arts & Afternoon Activities: 12:30pm - 3:30pm

Closing Celebration Service: 3:30pm - 4:00pm
Who are you registering?*

StudentAdult/Leader
Name*

First NameLast Name
Gender at Birth*

MaleFemale
Date of Birth*

MonthDayYear
Date
Registrants Email*
example@example.com
Registrants Phone Number*
Please enter a valid phone number.

CHURCH INFORMATION
Church Name*
Church City*
Children's Pastor/Leader Name:*
Children's Pastor/Leader Phone Number*
Please enter a valid phone number.
Children's Pastor/Leader Email (needed for confirmation)*
example@example.com

PARENT/GUARDIAN INFO
Parent/Guardian Name*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

EMERGENCY CONTACT
Emergency Contact Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Is the registrant's mom or dad a credentialed minister or missionary with the Assemblies of God?*

YesNo

MEDICAL/CONSENT
Allergies or Medical Conditions *
While at the even, will the student be taking any medications?*

YesNo
Medications he/she will be bringing to the event
Child is free from contagious health problems*

YesNo
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 Network Winter Blitz. 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 2025 Network Winter Blitz, 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 Winter Blitz 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*

I have read and agree to the Medical Treatment Authorization & Liability Release stated above, and I give my student permission to participate in the 2026 Network Winter Blitz and all related activities.I have read and agree to the Media & Promotional Release stated above and give permission for my student's image, likeness, and/or voice to be used as described.
Today's Date:*

MonthDayYear
Date
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.*

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LEADER/ADULT SECTION
Would you like to purchase a Winter Blitz T-Shirt for an additional $15?*

YesNo
Leader T-Shirt Size*
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.)*

YesNo

EMERGENCY CONTACT & CONSENT FOR LEADER/ADULT
Name of Emergency Contact*
Emergency Contact Relationship (Spouse, Friend, Pastor)*
Emergency Contact Phone Number*
Please enter a valid phone number.
I acknowledge that participation in the 2026 Network Winter Blitz 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.*

Yes
Leader Signature of ConsentBy 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 Network Winter Blitz.*

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PAYMENT
If you would like to pay by check 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 850-482-2986 and ask for Dana or email: dana.hicks@westflorida.ag

Registration Package + Shirt Order