2025 Kansas District High School Camp Individual Registration Form

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Select your camp event.* This field is required.
Kansas District High School Camp: June 6-9, 2025
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First & last name of attendee.* This field is required.
First Name
Last Name
3
Status of attendee.* This field is required.
Adult leader/Pastor
Camper/Student
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Contact email.* This field is required.NOTE: The confirmation email upon completion will be sent to this email address!
example@example.com
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Which church are you attending with?* This field is required.
Please Select
Please Select
Anthony Church of the Nazarene
Arkansas City Church of the Nazarene
Arkansas City Casa Del Alfarero
Augusta Church of the Nazarene
Bethel Church of the Nazarene
Chapman Church of the Nazarene
Cimarron Church of the Nazarene
Clearwater Church of the Nazarene
Derby Church of the Nazarene
Dodge City Church of the Nazarene
Dodge City Camino De Fe
Dodge City Nueva Esperanza
El Dorado Church of the Nazarene
Elkhart Church of the Nazarene
Emporia Church of the Nazarene
Garden City Primera Del Nazareno
Gaylord Church of the Nazarene
Great Bend Church of the Nazarene
Hoisington Church of the Nazarene
Hugoton Church of the Nazarene
Hutchinson Bethany Church of the Nazarene
Hutchinson Fe Viva
Hutchinson New Life
Iglesia Del Nazareno Betel
Inspire Church (Hutchinson 1st)
Junction City Church of the Nazarene
Larned New Beginnings
Liberal Church of the Nazarene
Lyons Church of the Nazarene
Manhattan Church of the Nazarene
McPherson Church of the Nazarene
Meade Church of the Nazarene
Newton El Calvario
Newton First Church of the Nazarene
Kinsely Pan De Vida Iglesia Del Nazareno
Plainville Church of the Nazarene
Pleasant Hill Church of the Nazarene
Pratt Abundant Harvest Community
Refreshed and Redeemed
Salina Belmont Boulevard
Salina First Church of the Nazarene
Severy Church of the Nazarene
Smith Center Church of the Nazarene
Spark United
Sublette Church of the Nazarene
The Dwelling Church
Turning Point Church of the Nazarene
Udall Church of the Nazarene
Ulysses Church of the Nazarene
Wellington Church of the Nazarene
Wichita Eastridge Nazarene Church
Wichita First Church of the Nazarene
Wichita Grace Church of the Nazarene
Indian Hills Church of the Nazarene
North Ash Church of the Nazarene
Wichita Todas Las Naciones
Wichita West Side Church of the Nazarene
Wichita Woodland Lakes Community Church
Winfield Church of the Nazarene
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City, State of your church location.* This field is required.Example: Wichita, KS
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Birth date of attendee.* This field is required.
Date
Month
Day
Year
8
Gender of attendee.* This field is required.
Male
Female
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Grade just completed.* This field is required.
Please Select
Please Select
N/A - Adult Leader
8th
9th
10th
11th
12th
10
Emergency contact name.* This field is required.
First Name
Last Name
11
Emergency contact phone number.* This field is required.
Please enter a valid phone number.
12
Name any FOOD allergies.* This field is required.If you or your student have a severe gluten or dairy allergy, we are unable to provide a supplement meal at this time. Please call the camp office at 417-858-9222 for further questions.
13
Name any DRUG allergies.* This field is required.
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Any other allergies?* This field is required.
15
List any medications the attendee is currently taking.(Please include any over-the-counter medications such as Advil, Ibuprofen, etc.) IMPORTANT: All medication (including over-the-counter drugs) must be brought to camp in their original pill bottle, not in a daily pill box, or a bag.
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Please tell us why they are on those medications.(Ex: Omeprazole- heart burn RETURN Melatonin- help sleeping Ibuprofen- headaches)
17
Please give the time the medications are to be distributed.(Ex: Omeprazole- Breakfast RETURN Melatonin- Bedtime Ibuprofen- as needed)
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Please indicate what dosage the medications are.(Ex: Omeprazole- 20mg RETURN Melatonin- 5mg Ibuprofen- 100mg)
19
Any additional comments regarding your student's health, or any additional medical history we should know about?
20
First & last name of parent/guardian.
First Name
Last Name
21
Phone number of parent/guardian.
Please enter a valid phone number.
22
Is your student allowed to go Cliff Jumping?VERY IMPORTANT! Fun in the Son Ministries, Inc. offers NO insurance coverage of any kind on our cliff jumping activity. By clicking YES for the activity, you unconditionally remove Fun in the Son Ministries, Inc. from any liability for your student participating in this activity. All other water activities are covered.
YESNO
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PARENTS: I, the undersigned, as the parent or legal guardian of the above camper, have read the lake activities information. I understand that, regardless of my students’ interest in this activity, I am choosing whether I will ALLOW or NOT ALLOW my camper to participate in the Cliff Jumping activity. Digitally sign your signature below
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Is your student allowed to receive authorized treatment by a licensed medical physician in case of any accident of illness that may arrive, or should hospitalization be necessary?
YESNO
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I, the undersigned parent or legal guardian of the above camper, a minor, do hereby authorize treatment of my child by a licensed medical physician in case of any accident of illness that may arrive, or should hospitalization be necessary. Digitally sign your signature below.
26
Can we use photos/video clips that may show your student at Camp Table Rock for promotional purposes? I.e on our website, social media, promotional videos, etc.If you select no, please send a separate email to campoffice.ctr@gmail.com with the student's name and a clear picture so we can screen them out.
YESNO
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Please submit a photocopy of your student's health insurance card.If you are unable to upload a picture of the student's health insurance card at this time please go ahead and submit this registration form and then email a copy to campoffice.ctr@gmail.com. Please do not reregister your student because you didn't upload the insurance card the first time.
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Please check out our FAQ page for any additional questions you may have in regards to dress code, packing list, etc. If you have any other questions, call the CTR Office (417)858-9222 or email campoffice.ctr@gmail.com.
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