General Information
Iowa Bible Camp 70th Annual Summer Camp - Sunday, June 21nd - Friday, June 26th. Submit a separate application for each child attending camp.
Camper Name
*
First Name
Last Name
First time camper?
*
Please Select
Yes
No
Male/Female
*
Please Select
Male
Female
Birthday
*
-
Month
-
Day
Year
Date
Age as of July 1st
*
Grade this coming fall?
*
Please Select
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
2025 Graduate
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of friend to share cabin:
Friend's age as of July 1st:
Name of friend to share cabin:
Friend's age as of July 1st:
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Medical History
Date of last tetanus shot?
*
-
Month
-
Day
Year
Date
Surgeries in the last year?
*
Type "None" if no surgeries
Reason for surgery?
Has camper ever had:
*
ADHD
Anxiety
Asthma
Autism
Bleeding Disorders
Convulsions
Diabetes
Ear Infections
Epilepsy
Fainting Spells
Hyperactivity
Kidney Disorders
Migraines
Rheumatic Fever
Seizures
Tuberculosis
None
Other
List any heart disorders.
*
Type "None" if no heart disorders.
List allergies:
*
(food, medicine, insects...) Type NONE if no known allergies.
List ALL current medications:
*
(medication name and dosage - Type NONE if no medications.
Will camper bring medications to camp?
*
Please Select
Yes - be sure to check them in at registration
No
List present injuries:
*
Type NONE if no injuries.
Food Restrictions:
*
Type NONE if no restrictions.
Activity Restrictions:
*
Type NONE if no restrictions.
My child may have the following medication on occasion, as needed for mild pain or bug bites.
*
acepaminophen
ibuprofen
benadryl
NOT ALLOWED
Other
Parent comments/notes:
Provide any additional information about your child's health that was not listed above.
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Camp Fee
Camp payment due with the application is appreciated. Pay online or make checks payable to Iowa Bible Camp and mail to: Christopher Swanson, 3301 Terrace Dr., Des Moines, Iowa 50312
Camp fee you are eligible for:
*
Please Select
1. $245 First time camper fee
2. $345 Regular camp fee
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Parent/Guardian Information
Parent/Guardian Name:
*
First Name
Last Name
Parent/Guardian Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email:
*
example@example.com
Emergency Contact Name: (Please provide someone other than the parent/guardian)
*
First Name
Last Name
Emergency Contact Phone Number:
*
Please provide someone other than the parent/guardian listed above.
Format: (000) 000-0000.
Emergency Contact Relationship:
*
Please provide someone other than the parent/guardian listed above.
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IBC Photo/Video Release
Check one:
*
Please Select
1. I hereby grant permission to Iowa Bible Camp (IBC) to use photographs and/or videos of my child in publications, news releases, online, social media, and in other communications related to the
mission of IBC.
2. I do not grant permission for Photo/Video Release
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Parent Agreement & Signature Page
I certify I have read and filled out the above questions and my answers are correct to the best of my knowledge. In consideration of the benefits derived from the Iowa Bible Camp, I hereby give my permission for the above named child to attend the camp and voluntarily waive any claim against its sponsor, director, and officials for any, and all causes that may arise from the activities of the camp. In the case of surgical or medical emergency, I hereby give permission to the physician selected by the camp director to hospitalize, to secure proper treatment for and to order injections, anesthesia, or surgery for the child named above.
Click to agree and sign below
*
I Agree
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Signature
*
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Twin Lakes Bible Camp Hold Harmless Agreement, Photo Release Waiver and Medical Release
Please read and sign below.
Camper Name
*
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Click to agree and sign below.
*
I Agree
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Signature
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