2025 North Arkansas District Individual Registration Form

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Select your camp event.* This field is required.
North Arkansas District: July 28-August 1, 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
Altus Church of the Nazarene
Batesville Church of the Nazarene
Beebe Church of the Nazarene
Bella Vista Church of the Nazarene
Bentonville Community Church of the Nazarene
Bentonville Hispanic Church of the Nazarene
Bethel Church of the Nazarene
Bethel Heights Iglesia del Nazareno
Blytheville Church of the Nazarene
Cabot Russell Chapel Church
Clarksville River Rock Church
Clarksville Time 2 Stand Church
Clinton Church of the Nazarene
Center Church (Conway)
Conway Harvest Church of the Nazarene
CrossRoads Cowboy - Natural Dam
CrossRoads Cowboy - Pleasant Plains
Crossroads Cowboy Church
Farmington Church of the Nazarene
Fayetteville First Church of the Nazarene
Fort Smith First Church of the Nazarene
Fort Smith River Valley Church of the Nazarene
Greenbrier Church of the Nazarene
Harrison Church of the Nazarene
Heber Springs Church of the Nazarene
Hickory Plains Church of the Nazarene
Hiwasse Church of the Nazarene
Jacksonville Church of the Nazarene
Jacksonville Nueva Vida Church
Jonesboro First Church of the Nazarene
Jonesboro Forest Home Church
Liberty Church of the Nazarene
Marion Cypress Creek Church
Marshall Church of the Nazarene
Maumelle New Start Church
Maumelle Trinity Life Church
McCrory Church of the Nazarene
Moravia Church of the Nazarene
Morrilton Church of the Nazarene
Mountain Home Twin Lakes Church
Mountain View - The Lookout Church
Osceola True Grace Gospel Church
Ozark Church of the Nazarene
Paragould First Church of the Nazarene
Paragould Woodland Hills Church
Pea Ridge Church of the Nazarene
Pickens Chapel Church of the Nazarene
Pleasant Hill Church of the Nazarene
Rogers First Church of the Nazarene
Rogers Primera Church of the Nazarene
Russellville Church of the Nazarene
Searcy Church of the Nazarene
Sherwood Church of the Nazarene
Siloam Springs Church of the Nazarene
Siloam Springs Nueva Vida Church
Springdale First Church of the Nazarene
Springdale Primera Church of the Nazarene
Van Buren Church of the Nazarene
Vilonia Church of the Nazarene
Vineyard Church of the Nazarene
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Birth date of attendee.* This field is required.
Date
Month
Day
Year
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Gender of attendee.* This field is required.
Male
Female
8
Grade just completed.* This field is required.
Please Select
Please Select
N/A - Adult Leader
6th
7th
8th
9th
10th
11th
12th
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Emergency contact name.* This field is required.
First Name
Last Name
10
Emergency contact phone number.* This field is required.
Please enter a valid phone number.
11
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.
12
Name any DRUG allergies.* This field is required.
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Any other allergies?* This field is required.
14
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.
15
Please tell us why they are on those medications.(Ex: Omeprazole- heart burn RETURN Melatonin- help sleeping Ibuprofen- headaches)
16
Please give the time the medications are to be distributed.(Ex: Omeprazole- Breakfast RETURN Melatonin- Bedtime Ibuprofen- as needed)
17
Please indicate what dosage the medications are.(Ex: Omeprazole- 20mg RETURN Melatonin- 5mg Ibuprofen- 100mg)
18
Any additional comments regarding your student's health, or any additional medical history we should know about?
19
First & last name of parent/guardian.
First Name
Last Name
20
Phone number of parent/guardian.
Please enter a valid phone number.
21
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
23
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.
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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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