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SWIM DAY
REGISTRATION

Parent/Guardian First Name*

Parent/Guardian Last Name*

Email*

Phone*

Address*

Child 1 First & Last Name*

Child 1 Birthday*

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Day

Year

Child 2 First & Last Name

Child 2 Birthday

Month

Day

Year

Child 3First & Last Name

Child 3 Birthday

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Day

Year

Child 4 First & Last Name

Child 4 Birthday

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Day

Year

Emergency Contact Name & Phone Number*

Please List Any Allergies (Including Food Allergies)*

Any other medical, physical, or behavioral concerns?

I hereby give Victorious LIfe Family Worship Center and its affiliates permission to photograph and video my child for advertising purposes.

I hereby release Victorious Life Family Worship Center and any other representatives of Camp Fusion from any and all liabilities in case of accident or injury.

OPENING HOURS

ADDRESS & PHONE

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CONNECT WITH US:

MON - FRI 3PM - 5:30PM

CAMP - MON - FRIDAY - 9AM - 3PM

8896 Richmond Drive

LaPlace, LA 70068

985.212.0553

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