Fuzion Athletics, Inc.

Camp Registration Information

 Camp Registration Form

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You have 2 options to register for a camp session. You can download the PDF and fill it out and return it to the address on the form with your payment, or you can fill out the form below and submit your information and you will be redirected to a Thank You page where you can Pay Now by using out 2CheckOut online payment process.

Personal Information

All Information is Required, Please read over our Privacy Policy for any concerns about your personal information.

First Name:   Last Name:    Weight:    (lbs.)

Address:        City:    State:    Zip:

Birth Date:   format: 01/01/0101   Age:

Contact Number: Format: 000-000-0000

E-mail:

M or F: -- Choose -- Male Female

Current School Name:   Year in School: -- Choose -- Freshman Sophmore Junior Senior

Vault Coaches Name:

Best Vault in a Meet:

T-Shirt Size: -- Choose -- S M L XL XXL

Any Medical Conditions (asthma, allergies etc.):

  

  

Insurance Information

Providers Name:

Policy Number:

Group Number:

CoPay:

Emergency Contact Information

Name of Friend/Family Member:

Contact Number:

Relationship To You:

Session Information

Indicate your preferred sessions:

Session Day and Time	Dates for Session
Sunday NOON Session	Session: -- Choose -- 1 = 11/2 - 12/7 -- Choose -- 2 = 12/14 - 1/25 -- Choose -- 3 = 2/1 - 3/8
Sunday 2PM Session	Session: -- Choose -- 4 = 12/14 - 1/25 -- Choose -- 5 = 2/1 - 3/8
Sunday 4PM Session	Session: -- Choose -- 6 = 2/1 - 3/8
Wednesday 7:15PM Session	Session: -- Choose -- 1 = 10/29 - 12/3 -- Choose -- 2 = 12/10 - 2/21 -- Choose -- 3 = 1/28 - 3/4
Saturday "Contact Jamie for Time" Session	Session: -- Choose -- 1/31 - 3/7

 

Electronic Signature:

BY E-SIGNING THIS APPLICATION YOU AGREE YOU HAVE EXPRESSED THE TRUTH TO THE BEST OF YOUR KNOWLEDGE AND ABILITY.