Rogersville Fall Camp 2024

WHERE: Clearwater Cove, Lampe, MO

WHEN: January 18-20, 2025

Departure: Saturday, January 18th from the Young Life Building (110 E Center Street, Rogersville)

Return: Monday, January 20th around 12:30 pm to the Young Life Building

COST: $160

After completing this form, a confirmation will be sent with the information you have entered below.

A short Health Form will need to be completed before the weekend. It will be emailed out separately at a later date.

Questions and Information

Contact Katie at [email protected] or 417-234-5309.

We are excited for a fun weekend with YOU!

Participant Information

Guest Type

Winter 2025

Clearwater Cove

Registration Options

Register with a full payment ($160.00)
Please select to make a full payment below. This will be paid by credit card.
Register with an offline payment. ($160.00)
To register without credit card information, select cash/check/offline. This option will also create a payment link for the full balance listed.

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Additional Comment

Ethnicity

School

High School Graduation Year

Additional Comments

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

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Phone Type

Parent/Guardian Email

Address is same as participant*

Address

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Total

$0.00

By filling out this form, you are opting in to Young Life communications.
In the future, you will be given the opportunity to manage your communication preferences.

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Offline

Credit Card

Visa
Mastercard
American Express
Discover

Address

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