Authorization and Medical Consent Form

Information received is confidential and is being gathered for the purpose of serving your child while in the care of the International Worship Centre. Any medical information collected here serves to authorize International Worship Centre and its staff and volunteers to obtain medical assistance in emergencies. 

Camp Participant Information

Parent/Guardian Information


Emergency Contact Information

Medical Information

Tip: 9-Digit Number

Purposes and Extent

International Worship Centre Inc. is collecting and retaining this personal information for the purpose of enrolling your child(ren) in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child(ren), and to inform you of program updates and upcoming opportunities at our International Worship Centre Inc. . This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish International Worship Centre Inc. to limit the information collected, or to view your child(ren)'s information, please contact us.

Informed Consent and Acknowledgement

I/We hereby grant my/our child permission to attend the Youth Camp 2023 at Manhattan Beach Retreat Centre from July 20 to 23, 2023.

I/we, the Parents or guardians named below, authorize International Worship Centre's authorized representative or ministry staff to sign a consent for medical treatment and to authorize any physician or hospital to provide

I undertake and agree to indemnify and hold harmless Ministry Volunteer(s), International Worship Centre Inc., and its Leaders from and against any loss, damage or injury suffered by the participant(s) as a result of being part of the activities of International Worship Centre Inc., as well as of any medical treatment authorized by the supervising individuals representing International Worship Centre Inc. . This consent and authorization is effective only when participating in or travelling to events sponsored by International Worship Centre Inc.

By clicking "I accept" below, you are indicating that you have read, understood, and agree with the above.

Media Release

Photos & Videos are regularly taken and used by Uprising and IWC for ministry and promotional purposes.

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This next section is to ensure the safety and well-being of our students, staff, and volunteers during the ongoing pandemic.

Release of Liability, Waiver of Claims and Assumption of Risks for Uprising Youth Camp

By clicking "I Accept" below, you will waive certain legal rights, including the right to sue or claim compensation.


The individual named below (referred to as the "Child", "he/she", or "his/her") desires to participate in Uprising Youth Camp (the "Activity") provided by International Worship Centre (the "Organization") at Manhattan Beach Retreat Centre , 1 Main St., Ninette, MB R0K 1R0. As lawful consideration for the intangible value that my Child will gain by participating in the Activity and being the parent/legal guardian of the Child (referred to as I or "me"), I agree to all the terms and conditions set forth in this agreement (this "Agreement").


  1. I am aware and understand the highly contagious nature of bacterial and viral diseases including, the 2019 novel coronavirus disease (COVID-19) (the "Disease") and the risk that my Child and I may be exposed to or contract the Disease by engaging in the Activity, which may result in serious illness, personal injury, disability, death, or property damage. I understand and acknowledge that these risks may result from or be compounded by the actions, omissions, or negligence of Organizations employees or others. I understand that while the Organization has implemented measures to reduce the spread of the Disease, the Organization cannot guarantee that my Child and I will not become infected with the Disease due to my Childs participation in the Activity. I ACKNOWLEDGE THAT I AM PERMITTING MY CHILD TO VOLUNTARILY PARTICIPATE IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGERS INVOLVED. I HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF INJURY, ILLNESS, DISABILITY, DEATH, OR PROPERTY DAMAGE ARISING FROM MY CHILDS ENGAGING IN THE ACTIVITY, WHETHER CAUSED BY THE NEGLIGENCE OF THE ORGANIZATION OR OTHERWISE.
  2. I hereby expressly waive and release any and all claims which I have or may in future have, against the Organization, and its officers, directors, employees, agents, representatives, affiliates, shareholders, successors, and assigns (collectively, "Releasees"), on account of injury, illness, disability, death, or property damage arising out of or attributable to my Childs participation in the Activity, whether arising out of the negligence of the Organization or any other Releasee or otherwise, including without limitation, breach of contract, or breach of any statutory or other duty of care. I covenant not to make or bring any such claim against the Organization or any other Releasee, and forever release and discharge the Organization and all other Releasees from liability under such claims.
  3. I confirm that my Child and I are: (a) in good health, in proper physical condition, and do not have any medical or other conditions that would impair my Childs ability to participate in the Activity; and (b) not experiencing symptoms of the Disease, do not have a confirmed or suspected case of the Disease, and have not come in contact in the last fourteen (14) days with a person who has been confirmed or suspected of having the Disease. I will comply with all federal, provincial, and local laws, orders, directives, and guidelines related to the Activity and the Disease, including, without limitation, requirements related to hand sanitation, social and physical distancing, and use of face coverings and safety equipment, and other guidance on the Disease from the Public Health Agency of Canada (PHAC). I will also follow all instructions, recommendations, and cautions of the Organization at all times during my Childs participation in the Activity. If at any time I believe conditions to be unsafe, that my Child is no longer in proper physical condition to participate in the Activity, or he/she begin experiencing symptoms of the Disease, I will immediately discontinue his/her participation in the Activity.
  4. I shall defend, indemnify, and hold harmless the Organization and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable legal fees, fees, and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, incurred by/awarded against the Organization or any other Releasees in a final non-appealable judgment, arising out or resulting from ANY claim of a third party related to my Childs participation in the Activity.
  5. This Agreement constitutes the sole and entire agreement of the Organization and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the Organization and me and our respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the laws of the Province of Manitoba and the federal laws of Canada applicable therein. without giving effect to any choice or conflict of law provision or rule whether of the Province of Manitoba or any other jurisdiction. Any claim or cause of action arising under this Agreement may be brought only in the courts of the Province of Manitoba, and I hereby consent to the exclusive jurisdiction of such courts.

I am the parent or legal guardian of the minor(s) named above. I have the legal right to consent and, by accepting below, I hereby do consent to the terms and conditions of this Release of Liability and Waiver of Claims.

By pressing "I accept" below, I acknowledge that I have read and understood all of the terms of this agreement and that I am voluntarily giving up substantial legal rights (on my behalf and on behalf of my heirs, executors, administrators, and next-of-kin), including the right to sue the Organization and the Releasees.

Witness of Acceptance

We also require that you accept these terms in the presence of a witness. 

By clicking "I accept" below, I, the Witness named above, hereby state that I am a witness to the acceptance of the terms and conditions of this Release of Liability and Waiver of Claims.


Please note that registration is not complete until full payment and a signed registration form are received.

No refund will be available before or after the registration deadline.
Please direct all inquiries to the Camp Director: Erika Joy Cruz, at


EARLY BIRD: $ 299.00                      REGULAR FEE: $330.00

March 07 - May 21                               May 22 - July 14


Payment can be made through Cash, Debit or Credit.

If you want to pay through PAYPAL, please click here and choose "UYC 2023 - RESONANCE"

You can also e-transfer your payment to .

Under the Notes section of your e-transfer, please put the following information:

- UYC2023

- Participant's Name

- Email 

- Phone number