2026 Royal Rangers JLDA Training Camp
Register for the JLDA event at Refuge AG Assembly, Panama City, June 4–7. Student Registration fee: $100.00 All meals, everything included!!!
Student or Leader
Student/Leader Name
*
First Name
Last Name
Parent Name /Emergency Contact
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you or your family a credentialed minister or missionary with the Assemblies of God?
Please Select
Yes
No
Event Dates
Location
JLDA Event Options
RTC
JTC
AJTC
JA
Leader
Medical Conditions
Diabetes
Hypertension
Asthma
Allergies
Heart Disease
Other
While at the event, will they be taking medication?
*
Please Select
Yes
No
List Medications and Instructions
They are free from contagious health problems?
Please Select
Yes
No
Please list any dietary instructions:
List any activities your child is NOT permitted to participate in:
Waiver
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 JLDA. 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 2026 JLDA, 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 JLDA 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.
Read and check both boxes if you agree with above permisions
*
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 JLDA 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.
DateTime
Signature
*
JLDA Event Registration Fee
*
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Registration Fee
$100.00 Online
$100.00
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100.00
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Registration Fee Cash/Check Pay
$100 At Registration
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Leaders Free
No Charge
Free
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Ministers and Missionaries
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Pastors Kids
$90.00
$90.00
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Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
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May
June
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October
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December
Expiration Month
Expiration Year
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Expiration Year
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