Camp Rooted August 1-4, 2024
August 1-4 | See details here:
https://memorialchurch.net/camp-rooted/
CONTACT
Tisha Spencer: 573-230-7795
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Grade completed
*
Please select all that apply.
6
7
8
9
10
11
12
Shirt Size
*
Please select all that apply.
Small
Medium
Large
XL
XXL
I understand my child may be swimming in a pool and in the Lake of the Ozarks and I give permission for them to be on the water slide, blob, canoes, etc. at the camp.
*
Please select one option.
I agree
I do not agree
I understand my child may be doing the high ropes course at their 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, my child may be exposed to illness and that is a risk I accept. Temp checks will be done before leaving and each return to camp if a student leaves.
*
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 my child sustains while at Camp Rooted 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
*
Parent Phone
*
Payment: You may pay by cash or check to the church office M-Th 9-1 or Sunday mornings
Regular Price ($100.00)
Pay by cash or check ($0)
Request a scholarship ($0)
Regular Price ($100.00)
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
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
August 1-4
See details here:
https://memorialchurch.net/camp-rooted/
CONTACT
Tisha Spencer: 573-230-7795
×
Please Fix the Following