Clone of 2026 Teen Summer Camp Registration Form

Camper's Name

First NameLast Name

Birth Date

MonthDayYear

Grade starting in fall

Gender

Address

Street Address

Mailing (if different than above)

CityState / Province

Postal / Zip Code

Shirt Size

Roommate Choice (optional, one choice only, no guarantees):

Name and City of Church

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.

Allergies, Chronic Illness or Conditions...

Does your child take any prescription or OTC medications on a regular basis? If yes, please list

Medication

Are there any OTC medications you do not wish your child to receive? If yes, please list.

OTC to NOT receive

List any physical problems that would limit activity or other physical problems (bed wetting, sleep walking...) :

Informed Consent and Acknowledgement

What to Bring: Bible(KJV), notebook & pen, sleeping bag/blanket, pillow, washcloth, towel, soap, toothbrush, toothpaste, comb, & any other toiletries. Clothes- jacket, casual clothes and tennis shoes for recreation (these clothes could get dirty), and dress clothes for chapel services. Other ideas: camera, ball glove, fishing equipment, and spending money (suggest $25-40) for canteen, bookstore & special activities.

Leave at Home: Leave all electronic devices (radios, MP3 players, tablets, computers, cell phones, etc), magazines/books, fireworks, & playing cards. Campers who bring tobacco products, alcoholic beverages, or illegal drugs will be sent home at their expense.

Insurance: Campers provide their own primary insurance. The camp provides secondary insurance only.

Friends of LWF are always welcome to visit. The evening services is a great time to visit. If possible, contact the camp at 319-592-3770 to let us know you are coming.

Dress Code:

God’s Word teaches the importance of modesty and distinction between male and female. As a Christian Camp we want to reflect Scriptural principles and ask our family campers, junior and teen campers, and staff to abide by the following rules while staying at Living Water Farms.
*All Campers All clothing must cover from neck to knee. Sleeveless or tight fitting clothing is not permitted. Living Water Farms reserves the right to request a change in any clothing or behavior deemed inappropriate.
*Girls/Ladies Modest, loose-fitting and knee-length recreational attire is appropriate for activities; no pants, gauchos, or capris. Spaghetti-strapped or low-cut shirts are not allowed. Knee-length skirts or dresses must be worn to each evening service. Skirt slits may not be higher than the knee. Modest one-piece swimsuits are required for girls during swim time. Modest one-piece swimsuits are required for girls during swim time.
*Boys/Men No shorts except during swim time. No sleeveless or see-thru mesh shirts. Pants and collared shirts must be worn to each evening chapel service. Knee-length shorts and t-shirts will be worn during swim time.

*Swim Time We have separate, supervised swim times for boys and girls.

I haveI read and understand the standards and important information listed above. I agree to abide by the standards of Living Water Farms, and I give permission to use my (child's) photographs in future publication/promotions.

Camper Signature

Parent/Guardian Information

Name

First NameLast Name

Phone Number

Format: (000) 000-0000.

Insurance Company and Policy #

Medical Release and Authorization

IN CASE OF EMERGENCY, I understand every effort will be made to contact parents or guardians. In the event that I cannot be reached, I hereby give permission to the physician selected by Living Water Farms to hospitalize and secure the proper medical treatment for, and other injection or anesthetic or surgery for my child as named on this form. I realize my insurance will be billed for any medical treatment as the primary coverage for my child.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Parent or Guardian Signature

Please verify that you are human

Email Address to receive registration confirmation

example@example.com

Online Payment- Choose ONE (contact us for new friend discount coupons)

Complete Payment

$150.00

Pre-Registration

Payment will count towards total

$25.00

Enter coupon

Total

Payment Methods

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

Junior Summer Camp Registration

Total Cost: $150 per camper

Child Information

Online Payment- Choose ONE (contact us for new friend discount coupons)

Payment Methods