Clone of 2025 Iowa District Individual Registration Form

1
Select your camp event.* This field is required.
Iowa District Week 1: July 20-24, 2026
Iowa District Week 2 & North Ark: July 27-31, 2026
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
Which church are you attending with?* This field is required.
Please Select
Please Select
Britt Zion Church of the Nazarene
Burlington First Church of the Nazarene
Cedar Rapids First Church of the Nazarene
Oakland Church of the Nazarene
Clarion Lighthouse Church of the Nazarene
Council Bluffs First Church of the Nazarene
Crossroads Community Church of the Nazarene
Davenport Church of the Nazarene
Des Moines First Church of the Nazarene
Des Moines Revive Church of the Nazarene
Des Moines Southside Church of the Nazarene
Dubuque Church of the Nazarene
Evansdale Hope Church of the Nazarene
Fairfield Church of the Nazarene
First African
Fort Dodge Church of the Nazarene
Fort Madison Living Hope
Grace Pointe Church of the Nazarene
Greater Iowa City Church of the Nazarene
Greater Life Community
Keokuk Church of the Nazarene
Knoxville First Church of the Nazarene
Marshalltown Church of the Nazarene
Mason City Church of the Nazarene
Missouri Valley Sunrise Community
Montrose Church of the Nazarene
Moravia Lighthouse Church of the Nazarene
Newton New Life Community
Oskaloosa Gateway Church of the Nazarene
Ottumwa Trinity Church of the Nazarene
Pella Church of the Nazarene
Red Oak Church of the Nazarene
Shenandoah Church of the Nazarene
Spencer Family Church of the Nazarene
St Paul United Church of Christ
Tabor Weaver Memorial Church of the Nazarene
Transformation Nazarene Church
United in Christ
Wapello Church of the Nazarene
Winterset Church of the Nazarene
6
Birth date of attendee.* This field is required.
Date
Month
Day
Year
7
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
9
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.
13
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?* 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
22
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
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? * This field is required.
YESNO
24
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.
25
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
26
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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