CO2 Retreat

Aug 2 (evening) - Aug 4 | See details here:
https://memorialchurch.net/camp-rooted/

CONTACT
Tisha Spencer: 573-230-7795

Payment is due by July 15th.

Name

This address will receive a confirmation email

Phone

I understand I may be swimming in a pool and in the Lake of the Ozarks accept the risks associated with the water slide, inflatable challenge course, canoes, etc. at the camp.

Please select one option.

I agree I do not agree

I understand my I may be doing the high ropes course at my own risk. There will be a certified ropes camp leader there at all times.

Please select one option.

I agree I do not agree

I understand that while precautions will be made for COVID 19 and other illnesses, I may be exposed to illness and that is a risk I accept.

Please select one option.

I agree I do not agree

Waiver: I release Memorial Baptist Church and Encounter Cove and volunteers from any injury that I sustain while at Camp Rooted/CO2 Retreat located at Encounter Cove in Roach, Missouri. I understand that I am responsible for any medical care required in the event of injury. This shall serve as my legal signature.

Please select all that apply.

I Agree

Parent Name (in case of emergency)

Parent Phone

Payment: You may pay by cash or check to the church office M-Th 9-1 or Sunday mornings

Regular Price (65.00) Pay by cash or check ($0) Request a scholarship ($0)

Amount

For office use only

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Aug 2 (evening) - Aug 4

See details here:
https://memorialchurch.net/camp-rooted/

CONTACT
Tisha Spencer: 573-230-7795

Payment is due by July 15th.

CO2 Retreat

Description

Please Fix the Following