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A Note About 2025

A Note about Registration This Year:
1. There will be an opportunity at the end of the registration form to donate to the "compassion fund."
2. If you discover anomalies or problems with this feature, please contact Aaron Cozort during registration (901-625-0900).
3. A receipt is emailed to you at the end of your registration after your payment is successful that will list everything with a $ amount attached to it on a single document.
Important Information - Early Bird Registration

36th Annual Homeschool Fellowship for Members of the churches of Christ

Online early registration is due by August 16th. The early registration fee is $50.00. Regular registration is from August 16th - September 1st and the fee is $85.00.

The remainder of your RoundHouse balance is due at RH registration or may be paid early by mail or by credit card.

If you desire to prepay all or part of your RoundHouse balance, please mail payments to:

RoundHouse
246 Funderburk Lane
Tallassee, AL 36078

Make checks payable to:
RoundHouse

If cancellation is necessary money will be refunded in a timely manner (minus processing fees).



Payment options:

Our payment processing is done through SQUARE. You do not have to have a SQUARE account to pay for registration.

Credit & Debit Card **2025**

  • Credit Card (Visa, MC, Discover, AMEX)
  • Debit Card

Additional Links ****2025 UPDATE****We recommend pulling up these PDFs of additional information on your computer, for reference while filling out this form..

They include things like the schedule, lodging information, and suggestions on what to bring if you're lodging in certain areas.

Lodging options have changed this year, please download this PDF to see updates to the lodging options. If you would like photos of lodging options, Bonclarken has a new page where that can be viewed: www.bonclarken.org/site-facilities/lodging/.
Adult Information
What Kind of Registration Applies to you?Family Registration
Total Number of People Attending RH This Year7
Number of Adults/Parents in your Family2
Adult/Parent 1 - NameNathan Cozort
Adult/Parent 1 - StatusFather
Adult/Parent 1 - Birth Date04/23/1985
Adult/Parent 1 - Phone(816) 832-4181
Adult/Parent 1 - Attending This Yearyes
Adult/Parent 1 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)No
Adult/Parent 2 - Name:Ashley Cozort
Adult/Parent 2 - StatusMother
Adult/Parent 2 - Birth Date01/04/1987
Adult/Parent 2 - Phone(816) 832-4361
Attending This Yearyes
Adult/Parent 2 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)No
Number of Children(This section may be empty if you are filling out a grandparent or individual adult form)
How Many Children Do You Have? (Put 0 if coming without children)5
Child Information
Child 1Madison
Child 1 - Birthday07/10/2007
Child 1 - Gender
  • Female
Child 1 - Baptized?
  • Baptized-Yes
Child 1 - Attending This Year?
  • Attending-Yes
Child 1 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)Yes
Child 1 - List of Allergies/Health Conditions or Restrictions
  • Gluten Free
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Child 2Hallie
Child 2 - Birthday08/28/2009
Child 2 - Gender
  • Female
Child 2 - Baptized?
  • Baptized-Yes
Child 2 - Attending This Year?
  • Attending-Yes
Child 2 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)No
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Child 3Lucy
Child 3 - Birthday04/18/2012
Child 3 - Gender
  • Female
Child 3 - Baptized?
  • Baptized-Yes
Child 3 - Attending This Year?
  • Attending-Yes
Child 3 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)Yes
Child 3 - List of Allergies/Health Conditions or Restrictions
  • Gluten Free
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Child 4Charlotte
Child 4 - Gender
  • Female
Child 4 - Baptized?
  • Baptized-No
Child 4 - Birthday07/05/2018
Child 4 - Attending This Year?
  • Attending-Yes
Child 4 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)Yes
Child 4 - List of Allergies/Health Conditions or Restrictions
  • Gluten Free
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Child 5Evelyn
Child 5 - Birthday08/21/2020
Child 5 - Gender
  • Female
Child 5 - Baptized?
  • Baptized-No
Child 5 - Attending This Year?
  • Attending-Yes
Child 5 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)No
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Family Information
Address:31303 E. Colbern Rd.
Grain Valley, MO 64029
United States
Map It
Email:Email hidden; Javascript is required.
Required Emergency Family Information Form
Family Emergency Information - Family Name:Cozort
Insurance StatusInsured
Insurance Information: Insurance Provider Company Name:Aetna
Insurance Policy Number:102053906600
Emergency Insurance Services Contact Phone Number1844-365-7373
Emergency Family Contact: Name:David Heck
Emergency Family Contact: Relationship:Father-In-Law
Emergency Family Contact: Phone Number:816-457-9739
General Family Information
Home Congregation:Oak Grove Church of Christ
Adult Male's Occupation:Preacher
Adult Female's Occupation:Administration Expert
RoundHouse Attendance Information
Is This Your First Year At Roundhouse?FirstYear-No
Number of Years Attending RoundHouse:35
Are You Currently Homeschooling?Yes
Number of Years Homeschooling:14
Did You Have a Graduating Senior(s)?Senior-No
Do you have any special needs children?SpecialNeeds-No
Lodging Registration Form
Please check the nights you will be staying:
  • Saturday
  • Sunday
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
Register at the YAB (Youth Activities Building)

When you arrive, please register first in the YAB, before unloading.

Sunday registration is 6:00 - 10:00p.m. No check-in before 6pm on Sunday. If your arrival is Sunday after hours or the next day, please call Shea Cozort in advance of your arrival so someone will be expecting you (217-220-2329).

Lodging Details
Lodging SelectionOther
Other: DetailsDixon & A. Richardson
Single-Bed DescriptionWe will select the cottage currently available for lodging singles year by year.
You will be informed of the selection when your registration is processed.
Heidelburg Description.

Heidelburg Rooms - Details

2nd floor only, Beckham Room
no elevator, no kitchen,
no cooking,
eating allowed in rooms,
NO HEAT & NO AIR in rooms,
closest lodging to Convocation Hall Kitchen.

Heidelburg House - Suites

Heidelburg Suites - Details

2nd Floor,
no elevator, no kitchen,
no cooking,
eating allowed in rooms,
NO HEAT & NO AIR in rooms,
closest lodging to Convocation Hall Kitchen.

Memorial Hall - Rooms

Memorial Hall - Single Rooms - Details

3 Rooms, 2 on First Floor, 1 on Second Floor
First floor rooms have 1 queen bed and a private bath.
Single rooms 7,10 = Cap. 2, 1Q, PB
Second floor room has 2 queen beds and a private bath.
Single room 22 = Cap. 4, 2Q, PB
Community kitchen area with refrigerator, microwave, coffee maker in basement.
no cooking in rooms,
eating allowed in rooms,
HEAT & AIR in rooms,
Located at top of hill between Heidelberg and Draffin

View Details and Photos of this lodging location

Memorial Hall - Suites

Memorial Suites - Details

MEMORIAL HALL - 2 levels, NO elevator.

14 Suites, 6 on First Floor, 8 on Second Floor
First floor suites are A-F.
Second floor suites are G-N.
Suites: A, B, C, E, F, G, H, J, K = Capacity 4 (All Twin Beds)
Suites: D, L = Capacity 5 (All Twin Beds)
Suites: M, N = Capacity 5 (4 Twin Beds + 1 Loft Bed)
Suite: I = Capacity 7 (2 Queens, 3 Twins)

Community kitchen area with refrigerator, microwave, coffee maker in basement.
no cooking in rooms,
eating allowed in rooms,
HEAT & AIR in rooms,
Located at top of hill between Heidelberg and Draffin

View Details and Photos of this lodging location

The Lodge (Description)

The Lodge - Details

All rooms are standard hotel rooms with queen beds, private bath and capacity of 4 unless otherwise indicated.
Handicap Accessible Rooms
4 levels, elevator,
All rooms have heat and air.
Reasonable distance to Convocation Hall kitchen and dining hall.
Laundry available.
Ice machines.
Kitchen has microwave and refrigerator.
NO COOKING is allowed in rooms.
Cooking is allowed in 1st floor kitchen using microwave and crockpots.
Eating is allowed in the rooms.
This building is located on top of the hill.

View Details and Photos of this lodging location

Founders South

Founders South - Details

Single level, motel style lodging.
Rooms 1-7 and 10-16 have 2Q beds with a capacity of 4.
Rooms 8–9 have 1Q bed with a capacity of 2.
Newly renovated, rooms have heat & air, private baths with large shower and a shower seat.
No cooking allowed. Kitchen access in Convocation Hall.
Eating in room is allowed.
Drive up parking for each room.
Located behind Founders Hall and next to the Lodge

View Details and Photos of this lodging location

Faith Apartments (Details)

Faith Apartments - Details

6 apartments with capacity of 6 persons each.
Full kitchen, cooking allowed.
Downstairs: living room with a queen-size sofa sleeper, eat-in kitchen, ½ bath & screened porch.
2 levels, no elevator
Upstairs: 2 bedrooms: 1 Queen bed, 2 Twin Beds, full bath between the rooms.
All apartments have heat and air.
Kitchens include: microwave, toaster, coffee maker & high chair.

View Details and Photos of this lodging location

Janeen Cottage (Details)

Janeen Cottage - Details

Individual rooms. Community Bathrooms.
9 bunk beds sleeps 18,
plus 1 Double Bed, Cap 2.
Total 20 each side.
Bathroom:
3 toilets, 3 showers, 2 sinks (each cottage).
single level,
full kitchen (refrigerator, sink, stove),
cooking allowed.

View Details and Photos of this lodging location

Bigger Lodge (Details)

Bigger Lodge - Details

8 Bedrooms
Each room: 1 Bunk bed, Capacity 2,
common baths (Women downstairs; Men upstairs).
no elevator,
Kitchen: No cooking. No electric skillets.

Crock pots are allowed for reheating precooked foods ONLY.
refrigerator, sink, washer & dryer,
large meeting room.
Across street from Old Gym and near Lakeview Apartment.

View Details and Photos of this lodging location

Minister’s Apartments (Details)

Minister’s Apartments - Details



2 Levels, no elevators
4 small apartments (old house converted to apts.).
cooking allowed.
Each apt.:
eat in kitchen (with coffee maker), bathroom,
2 small bedrooms - 1 Double Bed, 2 Twin Beds, Capacity 4.
Bedrooms are too small to put anybody on floor.
All apartments share a common living room on the 1st floor.
Outside entrance into each kitchen and common area.
Covered porch.
All have heat and air.
Parking nearby.

View Details and Photos of this lodging location

White Oak Cottage (Details)

White Oak Cottage - Details

2 levels, no elevator,
kitchenette with refrigerator,
sink and microwave,
and small common area on 1st floor.
Central heat and air
Crock pots are allowed for reheating precooked foods ONLY.
No cooking.
No electric skillets.
Midway on hillside, no parking near building

View Details and Photos of this lodging location

Agape Cottage (Details)

Agape Cottage - Details

3 levels, no elevator,
kitchenette with refrigerator,
sink and microwave,
and small common area on 1st floor.
Central heat and air
Crock pots are allowed for reheating precooked foods ONLY.
No cooking.
No electric skillets.Midway on hillside, no parking near building

View Details and Photos of this lodging location

Campground (Details)

Campground - Details

Designated sites with water and electricity at each.
Bathhouse with laundry room attached.
Men’s and women’s restrooms with 3 sinks, 3 toilets, 3 showers each side.
Set-up Options:
Bonclarken will allow those registered for the campground to arrive and set-up at 1:00 p.m. Sunday afternoon.
Registration, however, will not begin before 4:00 p.m.
Instructions for identifying your site location:
Sites 1-10 set-up with electrical box as back right corner of your site;
Sites 11-23 set-up with electrical box as back left corner of your site.

Please observe this rule in order to accommodate everybody and for each to receive his full site.

Special Note: Please remember sound carries great distances at night. Therefore, please be respectful of those trying to sleep while you are visiting in the campground at night.

Thursday Night Option Available: If you desire to break camp on Thursday in order to ease departure on Friday, you may register for a room for Thursday night. Please indicate on this registration form that you are choosing this option. All regular room rates apply.

View Details and Photos of this lodging location

Number of Nights5
Current Sub-Total$93.00
Thursday night option

Thursday Night Option Available: If you desire to break camp on Thursday in order to ease departure on Friday, you may register for a room for Thursday night. Please indicate in the field below if you are choosing this option. All regular room rates apply.

Meals and Cooking Facilities Information
Cooking Information

2025 Details

The Lodging Option sheet indicates which lodging buildings allow cooking and which don’t. WE MUST FOLLOW THESE RULES. If it says “No Cooking” that is what it means, including outside of your door or building. Anybody without cooking facilities in their lodging will have use of a commercial kitchen (in Convocation Hall) to use Sunday through Thursday. Plan your evening meals accordingly. It is highly recommended you bring meals prepared ahead so they just need reheating. It will be a great time saver. (Freezing them helps keep your cooler cold longer). The lodging areas with kitchens have minimal cookware, bringing what you need would be recommended.

We have access to at least 3 ice machines for filling coolers. Please, do not let children play in ice machines! Some lodging accommodations have refrigerators available.

All meals are on your own unless you choose to buy supper from Bonclarken. Bonclarken will prepare and serve meals for dinner Tuesday through Thursday.

Evening Meals

SUNDAY and FRIDAY: All meals are on your own.

Monday: Grill out lakeside (Headsprings Pavilion): bring your own meal: meat, fixings and drinks. 5:00 p.m. Grills and campfire will be available.

Bonclarken Meals

Meals Available from Bonclarken:

  • Tuesday Supper
  • Wednesday Supper
  • Thursday Supper
The Bonclarken meals are a staff-served buffet.
A minimum of 20 meals are required for a meal to be provided. If we don't reach our minimum, Shea will contact those who were registered for that meal so you can make other plans.

Gluten free and dietary restriction meals are available, please mark applicable meals.

Total$93.00
Bonclarken Monday Lunch
Bonclarken Tuesday Lunch
Bonclarken Tuesday Supper
Current Grand Total$93.00
Bonclarken Wednesday Lunch
Current Grand Total$93.00
Bonclarken Wednesday Supper
Current Grand Total$93.00
Bonclarken Thursday Lunch
Current Grand Total$93.00
Bonclarken Thursday Supper
Current Grand Total$93.00
Roundhouse Clothing & Accessories
This Year's RH T-Shirt
Clothing Deadline

2025 Clothing order deadline: August 16th!!!

Clothing Descriptions2025 T-Shirts: Blue Dusk T-shirt with Aqua Lettering - $10.25 (sizes X-Small - X-Large); (sizes 2X-3X - $12.75)

Light Pink T-Shirts with white lettering: Not year specific; Same sizing as regular shirts - $9.50 (2X & 3X - $11.50)

White T-Shirts with black lettering for Tie-Dying: Not year specific; Same sizing as regular shirts - $10.25 (2X & 3X - $12.75)

Hoodies: 7.75 oz. pullover style, Blue Dusk with Aqua Lettering: Not year specific - (sizes Small - X-Large $32.00) ; (size 2X - $34.00); (size 3X - $36.00)
Current Grand Total$93.00
Pink RH T-Shirt
Current Grand Total$93.00
White RH T-Shirt for Tie-Dying (Not Year Specific)
Current Grand Total$93.00
RH Hoodies, Onesies, and Caps
Current Grand Total$93.00
RH Totes
Current Grand Total$93.00
The Connection
Current Grand Total$93.00
Booth & Vendor Space Application
Booth & Vendor Space Application

Display space available for home businesses, including student items, may be requested, subject to approval by the Roundhouse Board. The cost will be $3.00 for half a table, and $6.00 for a full table (tables are 18" X 5’). You must have your own lockbox for cash purchases!!! No charge for Mission Work displays. Deadline: September 1st

Name of Business/ApplicantHallie's Stationary
Nature of BusinessArts and Crafts
Vendor/Display Spacetable-half ($3.00)
Missionary Display Spacemission-table-none
Current Grand Total$93.00
Free Book Display
Used Book Exchange

Space will be provided for a “used book exchange”. There will be no charge for this space. Be sure to put an envelope in each book with your name, name of the book and price. YOU ARE RESPONSIBLE FOR YOUR MATERIALS & MONEY.

Sports
Adventure Activities information

ADVENTURE ACTIVITIES:
Preregistration is required for these activities. They have a fee and are “first come first serve” for participation. We are obligated to pay Bonclarken for whatever we schedule.
Climbing Tower: Harness must fit correctly.(Must be at least 6 yrs. old) COST: $10.00 PER PERSON. This activity is scheduled for Tuesday afternoon. Time for climbing will be scheduled. This cost is for one day of climbing!
Zip Line: Must be at least 8 yrs. old, less than 250 lbs., not pregnant, and harness must fit correctly. This activity will occur on Wednesday. Cost: $10.00 PER PERSON.

Current Grand Total$93.00
Climbing Tower
Participant's Name Participant's Age
Charlotte 7
Climbing Tower - Total Number of Participants ($10.00 each)Climbing Tower - Total Number of Participants ($10.00 each), Qty: 1, Price: $10.00
Zip Line
Participant's Name Participant's Age
Lucy 12
Hallie 15
Nathan Older
Zip Line - Total Number of Participants ($10.00 each)Zip Line - Total Number of Participants ($10.00 each), Qty: 3, Price: $10.00
Current Grand Total$93.00
Disc Golf Tournament
Participant's Name Participant's Age
Nathan 40
Activities Registration Form
Bible Bowl Registration
Junior and Senior Bible Bowl Information

There are three divisions in Bible Bowl.  All questions will be from the New King James Version.  The Junior Division (ages 8-12) and the Senior Division (ages 13 – Senior High) will be using electronic Bible Bowl Equipment.  Each contestant will have a box with 3 switches labeled A, B, and C.  All questions are multiple choice.  Students flip a switch to indicate their answer.  Scorekeepers will record and count correct answers. There will be one round of 25 questions for the Senior Division, one round of 20 questions for the Junior Division. NO TIE-BREAKERS OR FINAL ROUND.  Proper preparation will require studying the book of 1 Corinthians.

Bible Bowl - Senior Division (ages 13-Senior High)
Participant's Name Participant's Age
Madison 17
Hallie 15
Lucy 13
Beginner Bible Bowl Information

The Beginner Division (age 3 - 7) is in center format.  Students rotate through each center display and complete certain tasks to learn lessons from the book of Exodus.  There will be an adult at each center to help with instructions and to do any reading necessary to operate the center.  Advance study and preparation is helpful, but not necessary for these little ones. Please, women and children only in this session.

Bible Bowl - Beginners (ages 3-7)
Participant's Name Participant's Age
Charlotte 7
Evelyn 5
Treasure Hunt Registration
Spelling Bee Registration
Olympics RegistrationTheme-related team events. No skills needed.
Olympics
Participant's Name
Hallie
Charlotte
Olympics - Captains or Judges
Captain or Judge's Name
Nathan
Tiny Tot Olympics Registration
Tiny Tot Olympics (Age 1-5)
Participant's Name
Evelyn
Dad's SessionDad’s only: We have scheduled a Dad’s Session (Mon. 1:00 – 2:30 p.m.). A general topic will be chosen but suggestions are welcomed.
Volunteer List for Roundhouse
Volunteer Registation Information

All alumni please volunteer! First year attendees are welcome to volunteer but it isn’t required. Assignments will be made by Board members covering that activity as soon as possible. Activity ideas are welcome!!! THANKS to all MOMS, DADS, & TEENS!!!

Use the + to add additional volunteers
Tiny Tot Olympics (Teen / Adult Helpers)
Volunteer's Name
Hallie
Lucy
Ashley (Organize)
Cookout cleanup
Volunteer's Name
Nathan
Ashley
Help parents without spouses during parent sessions
Volunteer's Name
Hallie
Lucy
Junior/Senior Bible Bowl Scorekeeper
Volunteer's Name
Nathan
RH Fair, reading to young children
Volunteer's Name
Ashley
Adventure Activities Volunteers
Adult Only Volunteers
Open (Unlock) & Close (Lock) Back Porch for Vendors (adults only)
Volunteer's Name
Nathan
Build bon fires (adults only)
Volunteer's Name
Nathan
Wednesday Night Free-Time Activity Chaperone (adults only)
Volunteer's Name 9:15-10:15 p.m. (Yes or No) 10:15-11:15 p.m. (Yes or No)
Nathan Yes
PowerPoint Operator for Devotions (adults)
Volunteer's Name
Nathan
Devotional VolunteersDevotion participation – enter the names of all those willing to participate, including students (all must be members of the church of Christ), remember we have separate ladies devotions Monday through Thursday mornings – ladies and girls please volunteer.
Song Leader
Volunteer's Name
Nathan
Song Leader (Ladies Session)
Volunteer's Name
Hallie
Ashley
Prayer
Volunteer's Name
Nathan
Prayer (Ladies Session)
Volunteer's Name
Madison (evening only please)
Ashley
Scripture Reader
Volunteer's Name
Nathan
Scripture Reader (Ladies Session)
Volunteer's Name
Hallie
Lucy
Ashley
Lesson
Volunteer's Name
Nathan
Lesson (Ladies Session)
Volunteer's Name
Ashley
Terms and Confirmations
Current Grand Total$93.00
PLEASE NOTE BEFORE YOU HIT **NEXT**The review form on the next page may only display the first participant listed for each activity under Sports, Activities, and Volunteering.
Your Responsibilities

Your Responsibility

We are not a summer camp with a rigid schedule. All activities are optional. We are not camp counselors. This is a family week. You are responsible for your children during activities as well as free times. Please require your children under age 18 to keep curfew (in your lodging area at designated times). Moms who come without Dads can easily recruit help. Volunteers are ready and willing.

Please observe the following Bonclarken requirements:

  • 12:00am-7:00am quiet time.
  • Conserve energy and water wherever possible.
  • Please observe the posted speed limits. The streets are also the sidewalks.
  • No fireworks, firearms, skateboards, rollerskates, rollerblades, scooters.
  • Bicycles are permitted but NC INSURANCE REQUIRES bicycle riders must wear protective headgear.
  • No profanity, tobacco, alcoholic beverages or illegal drugs.
  • Fishing is permitted, no NC license is required.
  • Bonclarken Conference Center and RoundHouse Board Members and Staff will be held harmless for all injuries, damages, and losses arising out of all activities and any situations created on the premises by the user and/or members of their groups. BCC & RoundHouse will not be responsible for stolen or lost items nor damage to vehicles. Facility users enter and bring all personal items, equipment, and vehicles onto BCC premises at their own risk.
  • Please observe the following RoundHouse rules:
  • NO pets allowed-even in campground, except certified companion animals.
  • Please do not bring:
    • leggings (unless covered with a knee-length top),
    • tight form-fitting clothes,
    • cold-shouldered shirts/dresses,
    • t-shirts advertising alcohol, tobacco, gambling, any musical groups;
    • shorts;
    • sleeveless shirts and tanktops;
    • spaghetti straps;
    • low necklines;
    • bare midriffs;
    • short skirts/dresses,
    • and such like.
  • We strive for an atmosphere where all are able to keep their minds pure and spiritually focused. The RH Board does not desire to be a modesty police force. We prayerfully request your help. 1 Thess. 4:1-8.
Today's Cost (Registration Only)$50.00
Please Read all Requirements

PLEASE READ ALL REQUIREMENTS BEFORE SIGNING REGISTRATION FORM!!!

WE TAKE FULL RESPONSIBILTY FOR OURSELVES AND OUR CHILDREN. WE UNDERSTAND AND AGREE TO ABIDE BY THESE STATEMENTS AND REGULATIONS. BOTH PARENTS MUST SIGN THIS FORM, PLEASE.

We, as the Parents, Agree to Abide by these Terms -- This is binding as your signature
  • Father
  • Mother
RoundHouse Grand Total (incl. Registration)$93.00
Consent I agree to the privacy policy.
Review Your Selections *

The review form on the next page may only display the first participant listed for each activity under Sports, Activities, and Volunteering.



Adult Information
What Kind of Registration Applies to you?
  Family Registration
Total Number of People Attending RH This Year
  7
Number of Adults/Parents in your Family
  2
Adult/Parent 1 - Name
  Nathan Cozort
Adult/Parent 1 - Status
  Father
Adult/Parent 1 - Birth Date
  04/23/1985
Adult/Parent 1 - Phone
  (816) 832-4181
Adult/Parent 1 - Attending This Year
  Yes
Adult/Parent 1 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)
  No
Adult/Parent 2 - Name:
  Ashley Cozort
Adult/Parent 2 - Status
  Mother
Adult/Parent 2 - Birth Date
  01/04/1987
Adult/Parent 2 - Phone
  (816) 832-4361
Attending This Year
  Yes
Adult/Parent 2 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)
  No
Number of Children
How Many Children Do You Have? (Put 0 if coming without children)
  5
Child Information
Child 1
  Madison
Child 1 - Birthday
  07/10/2007
Child 1 - Gender
 
  • Female
Child 1 - Baptized?
 
  • Yes
Child 1 - Attending This Year?
 
  • Yes
Child 1 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)
  Yes
Child 1 - List of Allergies/Health Conditions or Restrictions
 
  • Gluten Free
Child 2
  Hallie
Child 2 - Birthday
  08/28/2009
Child 2 - Gender
 
  • Female
Child 2 - Baptized?
 
  • Yes
Child 2 - Attending This Year?
 
  • Yes
Child 2 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)
  No
Child 3
  Lucy
Child 3 - Birthday
  04/18/2012
Child 3 - Gender
 
  • Female
Child 3 - Baptized?
 
  • Yes
Child 3 - Attending This Year?
 
  • Yes
Child 3 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)
  Yes
Child 3 - List of Allergies/Health Conditions or Restrictions
 
  • Gluten Free
Child 4
  Charlotte
Child 4 - Gender
 
  • Female
Child 4 - Baptized?
 
  • No
Child 4 - Birthday
  07/05/2018
Child 4 - Attending This Year?
 
  • Yes
Child 4 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)
  Yes
Child 4 - List of Allergies/Health Conditions or Restrictions
 
  • Gluten Free
Child 5
  Evelyn
Child 5 - Birthday
  08/21/2020
Child 5 - Gender
 
  • Female
Child 5 - Baptized?
 
  • No
Child 5 - Attending This Year?
 
  • Yes
Child 5 - Allergy/Health Conditions or Restrictions (For Family Emergency Form)
  No
Family Information
Address:
  31303 E. Colbern Rd.
Grain Valley, MO 64029
United States
Map It
Email:
  [email protected]
Required Emergency Family Information Form
Family Emergency Information - Family Name:
  Cozort
Insurance Status
  Insured
Insurance Information: Insurance Provider Company Name:
  Aetna
Insurance Policy Number:
  102053906600
Emergency Insurance Services Contact Phone Number
  1844-365-7373
Emergency Family Contact: Name:
  David Heck
Emergency Family Contact: Relationship:
  Father-In-Law
Emergency Family Contact: Phone Number:
  816-457-9739
General Family Information
Home Congregation:
  Oak Grove Church of Christ
Adult Male's Occupation:
  Preacher
Adult Female's Occupation:
  Administration Expert
RoundHouse Attendance Information
Is This Your First Year At Roundhouse?
  No
Number of Years Attending RoundHouse:
  35
Are You Currently Homeschooling?
  Yes
Number of Years Homeschooling:
  14
Did You Have a Graduating Senior(s)?
  No
Do you have any special needs children?
  No
Lodging Registration Form
Please check the nights you will be staying:
 
  • Saturday (Not an official RoundHouse Day)
  • Sunday
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
Lodging Details
Other: Details
  Dixon & A. Richardson
Saturday Selection
  Heidelberg (Suite)
Booth & Vendor Space Application
Name of Business/Applicant
  Hallie's Stationary
Nature of Business
  Arts and Crafts
Sports
Climbing Tower
 
Participant's Name Participant's Age
Charlotte 7
Zip Line
 
Participant's Name Participant's Age
Lucy 12
Hallie 15
Nathan Older
Disc Golf Tournament
 
Participant's Name Participant's Age
Nathan 40
Bible Bowl Registration
Bible Bowl - Senior Division (ages 13-Senior High)
 
Participant's Name Participant's Age
Madison 17
Hallie 15
Lucy 13
Bible Bowl - Beginners (ages 3-7)
 
Participant's Name Participant's Age
Charlotte 7
Evelyn 5
Olympics Registration
Olympics
 
Participant's Name
Hallie
Charlotte
Olympics - Captains or Judges
 
Captain or Judge's Name
Nathan
Tiny Tot Olympics Registration
Tiny Tot Olympics (Age 1-5)
 
Participant's Name
Evelyn
Volunteer List for Roundhouse
Tiny Tot Olympics (Teen / Adult Helpers)
 
Volunteer's Name
Hallie
Lucy
Ashley (Organize)
Cookout cleanup
 
Volunteer's Name
Nathan
Ashley
Help parents without spouses during parent sessions
 
Volunteer's Name
Hallie
Lucy
Junior/Senior Bible Bowl Scorekeeper
 
Volunteer's Name
Nathan
Girls Song Leading Class (Girls Only)
 
Participant Name Participant Age
Lucy 12
RH Fair, reading to young children
 
Volunteer's Name
Ashley
Adult Only Volunteers
Open (Unlock) & Close (Lock) Back Porch for Vendors (adults only)
 
Volunteer's Name
Nathan
Build bon fires (adults only)
 
Volunteer's Name
Nathan
Wednesday Night Free-Time Activity Chaperone (adults only)
 
Volunteer's Name 9:15-10:15 p.m. (Yes or No) 10:15-11:15 p.m. (Yes or No)
Nathan Yes
PowerPoint Operator for Devotions (adults)
 
Volunteer's Name
Nathan
Devotional Volunteers
Song Leader
 
Volunteer's Name
Nathan
Song Leader (Ladies Session)
 
Volunteer's Name
Hallie
Ashley
Prayer
 
Volunteer's Name
Nathan
Prayer (Ladies Session)
 
Volunteer's Name
Madison (evening only please)
Ashley
Scripture Reader
 
Volunteer's Name
Nathan
Scripture Reader (Ladies Session)
 
Volunteer's Name
Hallie
Lucy
Ashley
Lesson
 
Volunteer's Name
Nathan
Lesson (Ladies Session)
 
Volunteer's Name
Ashley
Terms and Confirmations
We, as the Parents, Agree to Abide by these Terms -- This is binding as your signature
 
  • Father
  • Mother
Consent
  I agree to the privacy policy.
Section Break
Would you like to donate to the RoundHouse compassion fund?
 
  • No
Credit / Debit Card
  MASTERCARD
XXXXXXXXXXXX9483
Nathan E. Cozort
Order
Product Qty Unit Price Price
Other - Choose this option if sharing lodging with another family - Please notify Shea Cozort of details - $0.00
5 $0.00 $0.00
Half a Table ($3)
1 $3.00 $3.00
None
1 $0.00 $0.00
Climbing Tower - Total Number of Participants ($10.00 each)
1 $10.00 $10.00
Zip Line - Total Number of Participants ($10.00 each)
3 $10.00 $30.00
Today's Cost: RH Early Registration (Online)
1 $50.00 $50.00
Subtotal $93.00
Total $93.00

Section Break
Would you like to donate to the RoundHouse compassion fund?
  • No
Today's Cost: RH Early Registration (Online)Today's Cost: RH Early Registration (Online), Qty: 1, Price: $50.00
Credit / Debit CardMASTERCARD
XXXXXXXXXXXX9483
Nathan E. Cozort