Victory Lane Camp Registration Form

Thanks for your interest in Victory Lane Camp! Please complete this form and send your registration fee of $100 within two weeks of submitting this form. This will guarantee your space at camp. After we receive your fee, a Victory Lane Camp representative will guide you through the pre-camp process. Please allow three business days for the initial contact from a VLC representative. Due to limited space at our camps, please provide us with your first and second choice of camp dates.

Select One

Husband's Information

Wife's Information

Please list children in order of oldest to youngest

Address Information


Do you regularly interact with any other families who have children with disabilities?

Are you involved in any community organizations that help provide respite, help, or encouragement to special needs families? Examples include local churches, Mommy & Me Groups, Sports Teams, etc...

Do you attend a church?

Does your church have a ministry for special needs children?

Are there any other special needs families within your church?


Has your child been diagnosed with a physical disability?

Is your child currently being treated by a physician for this diagnosis?

Is your child currently receiving any therapies?

Does your family have medical insurance?

VLC Experience

1. Each adult family member will be asked to fill out a 24-question online personality profile. Are all adult family members willing to complete this prior to your time at camp?

2. It is essential for your entire family to fully participate in the entire camp program. Are you able to commit everyone to staying through the duration of camp?

3. Victory Lane provides an all-inclusive camp experience for your entire family and is an exceptional value at $100. In order to continue to provide this experience to many families for years to come, we are asking for your help. In addition to the $100 registration fee, we ask that you partner with Victory Lane Camp to fundraise $300 for the VLC Family Scholarship Fund prior to camp. You will be contacted by a Victory Lane Camp Fundraising Coordinator that will assist you with your fundraising strategy. (If you choose to opt out, you may pay the $300 with your own personal funds.)

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