REGISTRATION FORM | FusionYouthOutreach

Parent/Guardian First Name

Parent/Guardian Last Name

Phone

Address

Camper 1 First & Last Name

Camper 1 Birthday

Month

Day

Year

Camper 2 First & Last Name

Camper 2 Birthday

Month

Day

Year

Camper 3 First & Last Name

Camper 3 Birthday

Month

Day

Year

Camper 4 First & Last Name

Camper 4 Birthday

Month

Day

Year

Emergency Contact Name & Phone Number

Is the camper potty trained? (Camper must be potty trained, stop if not)

Please List Any Allergies (Including Food Allergies)

Any other medical, physical, or behavioral concerns?

Registration Fee (If having trouble with PayPal)

Registration Fee$35

Attendance Rates

5 Days Per Week

3 Days Per Week

If 3 days, which 3?

Tuition (not required right now) leave blank if not paying today...

3 Day Week of Tuition$70

One Full Week of Tuition$80

Tuition Per Session$320

Full Camp Tuition (discount)$600

Camp Fusion Shirt

Youth Size$13

Adult Size$15

Adult Size XXL$17

Camper 1 Shirt Size

Camper 2 Shirt Size

Camper 3 Shirt Size

Camper 4 Shirt Size

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.