Heartland Women's Conf 2024 Online Registration Written on April 25, 2024. Heartland Women's Conference 2024 Attendee's Full Name(*) Invalid Input Age of Attendee(*) Invalid Input Attendee's Email Address Invalid Input Attendee Phone Number(*) Invalid Input Attendee Street Address(*) Invalid Input City(*) Invalid Input State(*) Invalid Input Zipcode(*) Invalid Input Church Name of Attendee Invalid Input Requested Roommate Invalid Input Rooms are double occupancy. If there is someone you would like to room with please let us know. Total Amount Due Deposit — $100.00Balance after deposit — $100.00Total Cost — $200.00 Invalid Input The total cost of this conference is $200.00 per attendee with $100.00 due no later than August 1st. If you are wanting to mail a check instead of paying online, when you submit this registration and the Paypal screen opens just close it out and the registration will go through; however, it is not complete until payment is received in our offices. Form of Payment Paypal Invalid Input Paypal Check Submit Created on April 25, 2024. Hits: 995 Print
Father-Son Campout 2024 Online Registration Written on April 24, 2024. Father-Son Campout 2024 First Name(*) Invalid Input Last Name(*) Invalid Input Street Address(*) Invalid Input City(*) Invalid Input State(*) Invalid Input Zipcoe(*) Invalid Input How many are you registering(*) Invalid Input Names of those you are registering(*) Invalid Input Church Name(*) Invalid Input Type of accomodations(*) Tent CampingPrimitive Lodging Invalid Input Total Payment Due 1 person tent camping — $5.002 people tent camping — $10.003 people tent camping — $15.004 people tent camping — $20.005 people tent camping — $25.001 person primitive lodging — $8.002 people primitive lodging — $16.003 people primitive lodging — $24.004 people primitive lodging — $32.005 people primitive lodging — $40.00 Invalid Input You will be redirected to a paypal screen, if you choose to pay on site pleases simply close the paypal screen and the registration will still be submitted. Submit Payment by paypal or onsite Paypal Invalid Input Paypal Onsite Created on April 24, 2024. Hits: 400 Print
2024 Online Staff Application Written on March 30, 2023. Camp Staff Application 2024 Camp Selection Camp(*) Elementary Camp Middle School CampHigh School Camp Invalid Input Position Desired(*) Room CoachNurse/EMTInternAnyOther Invalid Input Staff Information First Name(*) Required Middle Name(*) Invalid Input Last Name(*) Required Preferred Name Invalid Input Suffix (Jr., III, etc.) Invalid Input Email(*) Invalid format Address(*) Required City(*) Required State(*) OKAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Required Zip Code(*) Required Cell Phone Invalid Input Alternate Phone Number Invalid Input Gender(*) Male Female Required Date of Birth (mm/dd/yyyy)(*) Required (mm/dd/yyyy) Social Security Number(*) Invalid Input Marital Status(*) SingleMarriedDivorcedWidowedEngaged Invalid Input Spouse Name Invalid Input (If Applicable) Emergency Contact Name Invalid Input Emergency Contact Phone Number Invalid Input T-Shirt Size(*) Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL Invalid Input Church(*) Required Pastor(*) Invalid Input Ministries you are involved in Invalid Input Have you worked/attended a Heartland Conference camp previously? Yes No Required If Yes, When and What Position Invalid Input Medical Information Medical Condition(s) or special needs or accommodations the camp needs to be aware of. Invalid Input Born Again YesNo Invalid Input When Invalid Input Baptized with Holy Spirit? YesNo Invalid Input When Invalid Input Do You Use TobaccoDrink Alcoholic BeveragesUse Non-Prescription DrugsTake Medication for Psychological Disorders - If so please listHave any Allergies - If yes please listHave any Handicaps or Conditions that would hinder you from participating in all aspects of camp? - If so please explainHave any Medical Training - If so please list Invalid Input Have you ever been convicted of a criminal offence (excluding minor traffic violations)? If so, explain YesNo Invalid Input Notes (additional info you want to submit) Invalid Input List two personal references (excluding pastor/youth pastor and family members) Reference #1 Name Invalid Input How long have you known this person? Invalid Input Ref 1 Street Address Invalid Input City Invalid Input State Invalid Input ZipCode Invalid Input Phone Invalid Input Reference #2 Name Invalid Input How long have you known this person? Invalid Input Street Address Invalid Input City Invalid Input State Invalid Input Zipcode Invalid Input Phone Invalid Input A Pastor Recommendation is required - please print the form, which is available under downloads, and have your pastor complete it and mail it in! E-Signature(*) I am willing to abide by the camp rules and policies, accept any position or assignment, room in the dorm or cabin to which I am assigned, and if necessary go beyond the duties assigned to my position. I also agree to refrain from unscriptural conduct or any conduct the camp leadership may deem inappropriate. I will fully cooperate in spirit.The information I have provided in this application is correct to the best of my knowledge. I have carefully read all the information provided in conjunction with this application form. I authorize any references or churches listed on this application to provide any information they have regarding my character and/or fitness for service in the Heartland Conference camping program, and I release all such references from liability for any damage that may result from furnishing such evaluations. I do hereby waive the right to examine this information.I authorize the Oklahoma Conference of the Pentecostal Holiness Church (d.b.a Heartland Conference IPHC) to perform a complete background check.This box will serve as an e-signature Required Created on March 30, 2023. Hits: 1603 Print
2024 Online Camp Form Written on March 30, 2023. Heartland Camp Registration Form 2024 Camp Selection Elementary Camp is CLOSED as that camp is full. (*) High School Camp Regular — $175.00Middle School Camp Regular — $175.00 Invalid Input Camper Information First Name(*) Required Middle Name Invalid Input Last Name(*) Required Preferred Name Invalid Input Suffix (Jr., III, etc.) Invalid Input Camper Email (optional — for announcements, etc.) Invalid format Address(*) Required City(*) Required State(*) OKAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Required Zip Code(*) Required Phone Invalid Input Gender(*) Male Female Required Date of Birth (mm/dd/yyyy)(*) Required (mm/dd/yyyy) T-Shirt Size(*) Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult 2XL Invalid Input Church(*) Required Has camper previously attended a Heartland camp?(*) Yes No Required Roommate Request Invalid Input Notes (additional info you want to submit) Invalid Input Camper E-Signature(*) Camper agrees to abide by the Heartland Conference camp rules. This box will serve as an e-signature Required Medical Information Medical Condition(s) or special needs or accommodations the camp needs to be aware of. Invalid Input Medications Camper Is Taking Invalid Input Known Allergies (besides medications) Invalid Input Known Medical Allergies Invalid Input Authorized Pick Up Invalid Input Person authorized to pick up this child if other than parent named on form. You must call to verify if this changes. Parent/Guardian Section Parent/Guardian Name(s)(*) Required Email for registration confirmation(*) Invalid format Re-enter email(*) Invalid format Photo and Video Release(*) I understand that photographs and videos including my child engaged in the activities of the Heartland Camping program may be used for future promotional purposes of the Heartland Conference. Invalid Input Emergency Contact Number(s) Invalid Input Indeminification(*) I hereby agree to hold harmless the Heartland Conference of the Pentecostal Holiness Church, the Church Education Ministries/Discipleship Ministries, and camp personnel in case of accident or injury sustained by my son/daughter at camp. Invalid Input Medical Authorization(*) I do hereby authorize the Heartland Conference Church Education Ministries Director or his appointee to consent to any x-ray exam, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care to be rendered to the above named minor under general or special supervision and upon the advice of a physician, surgeon or dentist licensed under law of the state of Oklahoma. Invalid Input Emergency Consent to Treatment(*) In giving this consent I recognize and understand that in situations where the above named minor requires immediate medical or hospital care it may not be possible to contact me, and that in such situations I authorize a physician, surgeon or dentist to exercise his/her professional judgment and assess the risk incident to and choose the necessary treatment from any available alternatives and to render such care and perform such treatment as his/her professional judgment determines to be necessary for the health or safety of the above named minor. Invalid Input OTC Medication Consent Medication Consent: I do hereby authorize the Heartland Conference Discipleship Ministries Director or her appointee to administer over the counter medications including but not limited to acetaminophen, ibuprofen, Benadryl. Invalid Input Parent E-Signature(*) As parent(s)/Guardian(s) of the above name minor, I/we do hereby give permission for camper to attend the Heartland Camp selected above. All information provided (including medical information) is true to the best of my knowledge. In the unlikely event that camper does not abide by the rules of the Heartland Camp, I/we will arrange for his/her early transportation home. Marking this box will serve as an e-signature. Required Pay by PayPal or Credit Card Created on March 30, 2023. Hits: 2860 Print
Ministers and Spouses’ 2022 Retreat Registration Written on February 8, 2022. Please complete all required fields! Thompson Lodge, Falls Creek March 25 – 26, 2022Early Day: March 24 Name(*) Invalid Input Email(*) Invalid Input Phone(*) Invalid Input Credentials(*) I am a licensed or ordained minister of the Heartland Conference of the IPHC Must indicate that you are a licensed or ordained minister of the conference to register My spouse will be attending(*) Yes No Invalid Input Spouse(*) Invalid Input Retreat Your Friday night stay, banquet and Saturday morning breakfast are paid by the Heartland Conference! No-Show Policy(*) I understand that I will be responsible for $160/couple or $120/single if I register and do not attend! Invalid Input Option 1 — Enjoy the Early Day You or your church can pay for you to come a night early! Many of our ministers do this since it allows for more relaxation! Send a check or make arrangements with our office to pay by credit card for the extra night. Early Day(*) Yes, I want to come early! No Invalid Input Room(*) Couple ($90) Single ($85) Invalid Input Breakfast Friday, March 25, 8:00-9:00 ($8.50/person) Invalid Input Lunch Friday, March 25, 12:00-1:30 ($10.00/person) Invalid Input Meal Cost Invalid Input Total Invalid Input Ministry Time Yes, I would like a special time for the prayer team to pray with me and share any prayer insights they receive! (If married, we welcome your spouse to join you in this special time) Invalid Input Option 2 — Stay a Night Later If you would like to stay over Saturday evening and Sunday, March 26 – 27, make arrangements directly with Falls Creek, 580-369-2101, and mention Heartland Conference. If everything is correct Submit Registration Invalid Input Created on February 8, 2022. Hits: 1358 Print
Prayer Summit 2021 Sign Up Form Written on May 1, 2021. Prayer Summit 2021 Sign-up Please complete all required fields! Thank your interest in Heartland Conference 2021 Prayer Summit. This event is limited to 50 attendees, and priority is given to our ministers who are leading their churches to become Houses of Prayer. The remaining openings are first come, first served to those who register. Full Name(*) Field required Email Address(*) Field required Phone Number(*) Please enter a phone number in this format: ***-***-**** Spouse information Spouse Attending Invalid Input Spouses' Name(*) Invalid Input My Church Invalid Input I am the pastor Invalid Input Please check all that apply I understand the effect of the Prayer Summit is cumulative. Therefore I commit to attending the full event. I would like to be considered as an alternate attendee if the Prayer Summit is already full. Invalid Input (*) Invalid Input Submit Submit Reset Created on May 1, 2021. Hits: 750 Print