Camp Victory Form / 2018 - 2019 / After School Program / Melbourne / McClure Events Center

August 10, 2018 - May 24, 2019, excluding school holidays | Camp Victory After School
1855 Lansing Street
Melbourne, FL 32935
 
 
 
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Family Information

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Insurance Information

 
 
 
General Consent

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Media Release

 
 
 
 
Mandatory Credit Card Authorization for Weekly Payments

Camp Victory full week after school program.
Please enter the necessary information so that Victory can withdraw $70.00 on Mondays during the school year.
 
 
 
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I authorize Victory Kid Sports to charge $70/week to the credit card listed on this form. I agree to pay for this purchase in accordance to the issuing bank cardholder agreement (Please date and put your signature in the box to confirm you agree with this weekly transaction)
 
 
Payment

 
$30.00
 
 
 
 
 
 

Description

August 10, 2018 - May 24, 2019, excluding school holidays
Camp Victory After School
1855 Lansing Street
Melbourne, FL 32935