Clone of 2025 Joplin District Individual Registration Form

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Select your camp event.* This field is required.PLEASE NOTE, Joplin Week 1 is full and not accepting further registrations.
Joplin District Week 2: June 12-16, 2026
Joplin District Week 3: June 16-20, 2026
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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
Anderson Iron Works Church of the Nazarene
Ava Highway Church of the Nazarene
Banner Church of the Nazarene
Baxter Springs Church of the Nazarene
Bolivar Church of the Nazarene
Bradleyville Church of the Nazarene
Branson First Church of the Nazarene
Buffalo Church of the Nazarene
Butler Church of the Nazarene
Camdenton Hispanic
Camdenton New Life
Caney Church of the Nazarene
Carl Junction Church of the Nazarene
Carthage First Church of the Nazarene
Casa Jaziel Church of the Nazarene
Cassville Church of the Nazarene
Chanute Church of the Nazarene
Cherryvale Church of the Nazarene
Christ Church Neodesha
Citizens Church of the Nazarene
Clinton Church of the Nazarene
Coffeyville Central Church of the Nazarene
Coffeyville First Church of the Nazarene
Cold Creek Cowboy Church
Columbus Connecting Point
Countryside Church of the Nazarene
Deepwater Crossroads Church of the Nazarene
Dogwood Church of the Nazarene
El Dorado Church of the Nazarene
Elk City Church of the Nazarene
Erie Church of the Nazarene
Faith Community Church of the Nazarene
Faith Journey Church of the Nazarene
Fort Scott Church of the Nazarene
Fuente de Auga Viva
Galena Parkhill Church of the Nazarene
Garnett Church of the Nazarene
Goodhope Church of the Nazarene
Houston New Horizon
Independence Church of the Nazarene
Iola Church of the Nazarene
Joplin Calvary Church of the Nazarene
Joplin First Church of the Nazarene
Joplin Traders Church of the Nazarene
Kingdom Church - Marshfield
Lamar Living Hope Church of the Nazarene
Lebanon Freedom Church of the Nazarene
Living Faith Church of the Nazarene
Living Water Church of the Nazarene
Mansfield Church of the Nazarene
Marionville Church of the Nazarene
Marshfield Hope Church of the Nazarene
McCune Church of the Nazarene
Monett Church of the Nazarene
Mount Vernon Church of the Nazarene
Neodesha Church of the Nazarene
Neosho Church of the Nazarene
Nevada Church of the Nazarene
New Life Church of the Nazarene Miami
Nixa Organic Church
Osceola Church of the Nazarene
Ozark First Church of the Nazarene
Parsons Church of the Nazarene
Pittsburg Church of the Nazarene
Pleasanton Church of the Nazarene
Powell Twin Springs Church of the Nazarene
Nixa Church of the Nazarene - Radiant Church - Nixa, MO
Radiant Life Church - New Strawn, KS
Reeds Springs Community
Republic First Church of the Nazarene
Rogersville Harvest Community
Sarcoxie New Beginnings
Seymour Church of the Nazarene
Solid Rock Cowboy Church of the Nazarene
Springfield Dayspring Church of the Nazarene
Springfield Grace Church of the Nazarene
Springfield One Life
Springfield Scenic Church of the Nazarene
Strafford Church of the Nazarene
The Table
The Well
Trinity Church of the Nazarene
Warsaw Church of the Nazarene
Webb City Church of the Nazarene
Wheatland Church of the Nazarene
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City, State of your church location.* This field is required.Example: Marshfield, MO
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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
9
Grade just completed.* This field is required.
Please Select
Please Select
N/A - Adult Leader
6th
7th
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.
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?* This field is required.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. * This field is required.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? * This field is required.
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. * This field is required.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.* This field is required.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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