Camp Victory Form / MERRITT ISLAND / Summer 2024

1) I understand there will be no camp on the following holidays: Monday, May 27, Wednesday, June 19, and Thursday, July 4.

Yes No

2) I understand my tuition includes daily breakfast and snack, and the field trip.

Yes No

3) I understand that my child must bring his/her lunch each day. No lunch is provided by Victory.

Yes No

4) I understand that my card will be charged on Thursday prior to the week of camp. If payment is not received, my child will not be allowed to attend camp on Monday. NO cash or checks are accepted at camp.

Yes No

5) I understand that if my child brings personal items to camp, Victory is not responsible for loss or damage.

Yes No

6) I understand that if my child needs any medication at camp that I will bring the medication with the medical form to the camp Director on the first day of camp. Children may not keep any kind of medication in their personal belongings.

Yes No

7) I understand that I will pay a per child $30 registration fee and a 1-week deposit per child that will be applied to the final week checked.

Yes No

8) I understand that the doors are unlocked at 7A and I must pick my child(ren) up NLT 6P.

Yes No

9) I understand this is a full 11-week program. I am registering for 11 weeks, I will pay for all 11 weeks (or 10 weeks if vacation week is selected), even if my child drops out. Each child is allowed 1 vacation week for a week they will not attend camp. (if you are looking for camp for partial weeks of summer please call (321) 216-2011 ext 705)

Yes

10) I understand that once I submit this form, no refunds will be issued.

Yes No

Parent's Information

Parent 1 / Guardian Name

This address will receive a confirmation email

Place of Employment

Please attach P1 photo for pick up purposes

Upload (8MB)

Do you have any constructive criticism on how we can improve the program? What are we doing well, what would you or your child like to see?

How did you hear about Victory Kid Sports?

Parent 2 / Guardian Name

Please attach P2 photo for pick up purposes

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Child 1 Date of Birth

Child 1 Age

Mature 4 - potty trained, experience in a full-day child care program Mature 5 - potty trained, experience in a full-day child care program 6 7 8 9 10 11 12 13 14 15

Child 1 Grade (going in to)

VPK K 1 2 3 4 5 6 7 8 9 10

Child 1 Allergies/Physical Conditions/Medication

Child 1 Does your child have behavioral or developmental difficulties? Please explain.

Is Child 1 interested in becoming a Jr Coach or CIT? Mature 5th -10th Grade ONLY (if Yes is selected, more details will be emailed to Parent 1 email address)

Child 1 Current Photograph

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If you would like a vacation week from the program, please choose ONE week which your child will not attend:

Week 1 - May 28 - 31 (no camp 5/27) Week 2 - June 3 - 7 Week 3 - June 10 - 14 Week 4 - June 17 - 21 (no camp 6/19) Week 5 - June 24 - 28 Week 6 - July 1 - 5 (no camp 7/4) Week 7 - July 8 - 12 Week 8 - July 15 - 19 Week 9 -July 22 - 26 Week 10 - July 29 - August 2 Week 11 - August 5 - 9

Child 2 - if there are multiple children, please complete ALL information for each additional child.

Child 2 Date of Birth

Child 2 Age

No additional children Mature 4 - potty trained, experience in a full-day child care program Mature 5 - potty trained, experience in a full-day child care program 6 7 8 9 10 11 12 13 14 15

Child 2 Grade (going in to)

No additional children VPK K 1 2 3 4 5 6 7 8 9 10

Child 2 Allergies/Physical Conditions/Medication

Child 2 Does your child have behavioral or developmental difficulties? Please explain.

Is Child 2 interested in becoming a Jr Coach or CIT? Mature 5th -10th Grade ONLY (if Yes is selected, more details will be emailed to Parent 1 email address)

Child 2 Current Photograph

Upload (8MB)

I understand this is a full 10-week program. If I am registering for 10 weeks, I will pay for all 10 weeks, even if my child drops out. Each child is allowed 1 free week vacation for a week they will not attend camp. Week 1 - May 28 - 31 (no camp 5/27) Week 2 - June 3 - 7 Week 3 - June 10 - 14 Week 4 - June 17 - 21 (no camp 6/19) Week 5 - June 24 - 28 Week 6 - July 1 - 5 (no camp 7/4) Week 7 - July 8 - 12 Week 8 - July 15 - 19 Week 9 - July 22 - 26 Week 10 - July 29 - August 2 Week 11 - August 5 - 9

Child 3 Date of Birth

Child 3 Age

No additional children Mature 4 - potty trained, experience in a full-day child care program Mature 5 - potty trained, experience in a full-day child care program 6 7 8 9 10 11 12 13 14 15

Child 3 Grade (going in to)

No additional children VPK K 1 2 3 4 5 6 7 8 9 10

Child 3 Allergies/Physical Conditions/Medication

Child 3 Does your child have behavioral or developmental difficulties? Please explain.

Is Child 3 interested in becoming a Jr Coach or CIT? Mature 5th -10th Grade ONLY (if Yes is selected, more details will be emailed to Parent 1 email address)

Child 3 Current Photograph

Upload (8MB)

Child 4 Date of Birth

Child 4 Age

No additional children Mature 4 - potty trained, experience in a full-day child care program Mature 5 - potty trained, experience in a full-day child care program 6 7 8 9 10 11 12 13 14 15

Child 4 Grade going in to)

No additional children VPK K 1 2 3 4 5 6 7 8 9 10

Child 4 Allergies/Physical Conditions/Medication

Child 4 Does your child have behavioral or developmental difficulties? Please explain.

Is Child 4 interested in becoming a Jr Coach or CIT? Mature 5th -10th Grade ONLY (if Yes is selected, more details will be emailed to Parent 1 email address)

Child 4 Current Photograph

Upload (8MB)

I understand this is a full 10-week program. If I am registering for 10 weeks, I will pay for all 10 weeks, even if my child drops out. Each child is allowed 1 free week vacation for a week they will not attend camp. Week 1 - May 28 - 31 (no camp May 27) Week 2 - June 3 - 7 Week 3 - June 10 - 14 Week 4 - June 17 - 21 (no camp 6/19) Week 5 - June 24 - 28 Week 6 - July 1 - 5 (no camp 7/4) Week 7 - July 8 - 12 Week 8 - July 15 - 19 Week 9 - July 22 - 26 Week 10 - July 29 - August 2 Week 11 - August 5 - 9

Additional Contact Information

Please list the name, cell phone #, and email address of anyone else (other parent, grandparents, etc) who you would like to receive emails and alerts for your child.

The following (other than P1) are authorized to pick up my child(ren). All information must be completed.

Please list anyone who is NOT allowed to pick up your child(ren)

Insurance Information

Family Physician & Phone Number

Hospital Preference

I/we am giving my child permission to participate in Victory Kid Sports I have read and agree to the terms and conditions, that are located at www.victorykidsports.org and I understand that I can request a copy via email, billing@victorykidsports.org.

Yes Option

Photos and videos may be taken and used for social media, print media, and marketing purposes. We understand the media release and we give permission for Victory to take videos and pictures of our children and for those photos/videos to be used on public media.

Yes No

Some of our movies are PG-13 Marvel superhero movies (i.e. Avengers Captain America, etc.) Some of our field trips include E-Rated games and FortNite (rated T-Teen) and laser tag. By selecting yes, you grant permission for your child(ren) to watch the movies and participate in the activities described.

Yes No

(for off-site field trip purposes only) We are excited to have your child with us a Camp Victory! We would like to request authorization from you to transport your child within central Florida. Please fill out the information below to provide us with the permission necessary for transportation. I grant permission to Victory Kid Sports to transport my child during Summer Camp.

Yes No

Click this link to order camp shirt(s) for your child(ren) to be directly shipped to you.

YOUTH sizes link:

https://victory-kid-sports.printify.me/product/4802677/vks-kids-camp-t-shirt-youth-sizes

ADULT sizes link:

https://victory-kid-sports.printify.me/product/5712209/vks-camper-t-shirt-adult-size

If you have any issues with the link or your order, send an email to info@victorykidsports.org.

Mandatory Credit Card Authorization for Payment

Victory will withdraw $175.00 (or $160.00 early bird) per child on Thursday, prior to your registered weeks. No cash or checks will be accepted at camp.

Expiration Date (Month/Year)

I authorize Victory Kid Sports to charge $175 (or $160 early bird) per child. 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 transaction.)

Please enter your discount code (if applicable)

How many children did you register?

Registration fee - $30 per child (a registration fee is required for each child.) (I understand that once I submit this form that no refunds will be given under any circumstance.)

Deposit applied to the last week you have selected. No refunds will be issued if you do not attend.

All deposit and tuition prices listed above are based on regular rates.

If your child(ren) are selected for the Junior Coach/CIT program, the rate that you are charged for that child will be reduced to:

Junior Coach: $87.50/week
CIT: $137.50/week

The $160 deposit will still be required at registration but will be applied to the final 2 weeks of camp checked on this form if your child is selected as a Junior Coach or CIT.

Victory Administration and staff have the right to revoke Junior Coach/CIT status if the child is struggling with responsibilities. Parents will be notified ahead of time if there is an issue.

Camp Victory Form / MERRITT ISLAND / Summer 2024

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