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

Please List Any Allergies (Including Food Allergies)

Any other medical, physical, or behavioral concerns?

Attendance Rates

5 Days Per Week

3 Days Per Week

Tuition

3 Day Week of Tuition$65

One Full Week of Tuition$75

Tuition Per Session$300

Full Camp Tuition (discount)$525

Camp Fusion Shirt *Required

Youth Size$12

Adult Size$14

Adult Size XXL$16

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.