Camper Information

Allergy Information


Vaccination History

Emotional/Social Health

General Health and Wellness Questions

Has/does the participant:

Medication and Medication Treatment

"Medication" is any substance a person takes to maintain and/or improve their health.  This includes vitamins and natural remedies.  All medications are collected, stored, and distributed by camp health care personnel.  Please list ALL medications (including over-the-counter or non-prescription drugs) taken routinely.  Bring only enough medications to last the entire time at camp.  Keep medications in the original packaging/bottles that identify the prescribing physician (if a prescription drug), the name of the medication, the dosage, and the frequency of administration.

Healthcare Providers

Restriction Information

Parent or Legal Guardian Information

Secondary Emergency Contact

Camp Session and Payment Options

***Senior Adult Retreat campers, please us this form to register:

***Each person attending Grand or Family camp must fill out a registration form!***

For Family Camp, the maximum fee per household is $300.  If you are registering 4 people or more , please enter the following coupon code on each family member's registration.

4 Family Members Registering: FAMILY4
5 Family Members Registering: FAMILY5
6 Family Members Registering: FAMILY6

Also, children ages 3 and younger are free to attend with their family.  Please complete a registration form for the child and enter UNDER3CAMPER in the coupon code box.

Regional camp scholarships are available! Please contact Lisa Grace ([email protected]; 515.255.3168) for more information and to request one.

Lodging Options: For Grand Camp and Family Camp only: Lodging is provided in our air conditioned cabins; however, if you would prefer, you may reserve a hotel-style Lodge Room for an additional $85 fee (1 fee per room).  Note: Only one (1) camper needs to select the option below for each room.


Authorization Information

You will be contacted if:

  • Your child is exposed to a communicable disease.
  • Outside medical attention is necessary (e.g. if we transport your child to a hospital or doctor's office).
  • Your child is having discipline problems that jeopardize the safety of others.

The undersigned person represents that he/she is the custodial parent/legal guardian of the above identified participant.  The camper has my permission to attend this session of camp at the Christian Conference Center.  This permission is given by me with full knowledge of the conditions and activities contemplated during each session (see for more information).  The participant has no physical or mental disabilities that would impair their participation except as noted above.  I acknowledge, agree to, reconfirm, and incorporate herein by reference the Release of Liability signed by me which is attached hereto.  I also understand that the information provided on this form will be kept confidential and shared only as necessary to provide care of the participant.  

I understand that camp insurance is a supplemental policy only.  It will pay whatever my own insurance does not cover (deductible or over) up to the limit of the policy.  If medical (sickness. injury) care is needed, billing will be sent to the parent/guardian who will be responsible for direct payments to physician, hospital, clinic, etc.

The participant is currently taking only medications listed above.  The camper has no allergies known to me except as noted on this form.  The health information/history is correct as far as I know.  In the event of illness or injury, I authorize the camp, physician, and/or hospital to undertake such treatment of and perform such services (including surgical) for the participant as are reasonably indicated by the circumstances.   

Unless checked below, I accept that the participant/s likeness may be used in any online or print publications or social media by the Christian Conference Center and/or the Christian Church in the Upper Midwest.

We are able to keep our summer camps affordable for our families because of donations from generous supporters.  Can you help us keep camp costs down?  Every gift helps us fulfill our mission to provide a safe, welcoming Christian camp experience to as many campers as possible.  Thank you!

Suggested Amounts

Refund Policy: If the camper must cancel or cannot switch to a different camp, the registration fee, minus a $20 processing fee, will be refunded. If your church has paid, the refund will go to them to be dispersed as they deem fit.

Billing Information

  • Visa
  • Mastercard
  • American Express
  • Discover
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