Camp Rooted

ATTN Parent/Guardian(s):
- Camp Rooted will take place at the Spirit Center, in Bluntzer, TX. 5528 FM3088, Robstown, TX 78380. $75 fee will be paid at check in. Checks can be made out to Diocese of Corpus Christi.
- Summer camp will be a lot of fun, and there will be a lot of outdoor activities, please make sure you are aware of the level of physical activity the camp requires, and if your child is unable to participate in specific activities, please let Sr. Caritas know ahead of time. They are welcome to attend! We want to make sure all the needs of the youth are being met.
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Parish*
Parish Name/City
Is your child attending camp with a parish group?*

YesNo
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState

Zip Code

Liability Form

The parent/legal guardian MUST be the one to complete this form.
I, Parent/Guardian · grant permission for my child, child's name* to participate in the “Diocesan Youth Camp ROOTED”, which takes place July 9^th – July 11^th, 2026 at the Spirit Center in Bluntzer, Texas (5528 FM3088, Robstown, TX 78380).
RELEASE, WAIVER AND INDEMNITY AGREEMENT

In consideration of my child’s participation in this diocesan program, I (Name of Other Parent)* agree on behalf of myself, our heirs, successors, executors, personal representatives and assigns to protect, indemnify, save, and hold harmless the Diocese of Corpus Christi, and their officers, directors, agents employee, or representatives associated with these activities mentioned above from all damages, claims, suits, expenses and payment on account of or resulting from any such injury, death, or damage to property, including resulting from the negligence of the Diocese of Corpus Christi, and their officers, directors, and employees arising from or in connection with my son/daughter attending these activities. In the event that any legal action is taken by either party against the other party to enforce any of the terms and conditions of this agreement, it is agreed that the unsuccessful party to such action shall pay to the prevailing party therein all court costs, reasonable attorney’s fees and expenses incurred by the prevailing party.

THE UNDERSIGNED HEREBY PERMITS THE DIOCESE, and media outlets to make and use photographic likeness of my son/daughter, in a still or video commercial, to be exhibited by television broadcasting and/or the internet at the said media outlets. The material will be used for news and/or Diocesan purposes. It will also be utilized in Diocesan print materials and any forms of media release and/or video produced to help the Diocese.

THE UNDERSIGNED further expressly agree(s) that the forgoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the laws of the State of Texas and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS (HAVE) READ AND VOLUNTARILY SIGN(S) THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT and further agree(s) that no oral representations, statements or inducement, apart from the foregoing written agreement, have been made.
Signature*
Date*

MonthDayYear
Date

Liability Form

Medical Consent

Insurance Information

Payment Options