2025 Reality Check Individual Registration Form

1

Select your camp event.* This field is required.

Reality Check: July 7-11, 2025

2

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

4

Contact email.* This field is required.NOTE: The confirmation email upon completion will be sent to this email address!

example@example.com

5

Full name of church.* This field is required.(Please do NOT only enter "First Baptist Church". Make sure to include the NAME of the church. Ex "House Springs First Baptist Church")

6

City, State of your church location.Example: Springfield, MO

7

Birth date of attendee.* This field is required.

Date

8

Gender of attendee.* This field is required.

Male

Female

9

Grade just completed.* This field is required.

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.

14

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.

16

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)

18

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

23

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

24

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

25

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.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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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.