Iowa Kids Camp Registration Form

Iowa Kids Camp Registration Form

This form along with the Health Form and the Code of Conduct must all be filled out for your child to attend camp.
Camper's Information
Camper Name
Name the Camper goes by
Date of Birth

MonthDayYear
School Grade Completed by time of camp
NOTE - Iowa Kids Camp is for children you have completed 1st through 5th Grade. If you have any questions whether your child is eligible please contact Ed Grant, camp director at 515-210-6310 or pastored4@msn.com
Is your Camper
May Camper Sleep on Top Bunk
Church you Attend
Is there a friend you want to bunk with? (We will do our best)
T-Shirt Size (after May 22 cannot guarantee size)
Parents' Information

Parent/Guardian
Parent/Guardian 1

First NameLast Name
Relationship to Child
E-mail
Best Phone Number to reach you
Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Deposit$20.00

Full Registration $300.00

Mult-Kid Registration $275.00

Only can use after paying the FULL Registration for the first chid

Enter coupon

Total $0.00

The Iowa Kids Camp has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.
Type first and last name above to consent
Sign Document
Date Signed

MonthDayYear
Camp Director Name and Contact Info

Debit or Credit Card

Choose from one of the PayPal options to make your payment.