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CODEXCEL 2024 GEEK SQUAD ACADEMY SUMMER CAMP
ENROLLMENT FORM

sponsored by

TO BE CONSIDERED FOR THE CODEXCEl GSA Summer camp, YOU MUST SUBMIT THIS enrollment form. We have limited number of slots available. register now to reserve your seat!

upon SUBMITTING YOUR APPLICATION OR ATTENDING A CODEXCEL EVENT, you hereby grant permission to VICTORY VILLAGE CORP AND ITS PARTNERS to use applicant information, contact data, and photographs and/or video of THE APPLICANT, THEIR INVITEES, FAMILY, FRIENDS, OR PARTICIPANTS taken on ALL DATES IN 2023-2024 at ALL LOCATIONS in publications, news releases, online, and in other communications related to the mission of VICTORY VILLAGE CORP. you further agree that victory village corp and its partners can contact the applicant and their guardians with the information provided. Thank you!

for students ages 10 - 18

First Name

Applicant's Age

Last Name

Applicant's Phone

GENDER IDENTIFICATION (FOR DIVERSITY REPORTING)

CURRENT SCHOOL NAME

PRIMARY Email

Parent/Guardian's Name & pHONE

Extracurricular Activities

none

football/basketball

volleyball/soccer/baseball

band

drama/art club (afterschool)

advanced placement (ap) or dual credit

afterschool technical program

other afterschool activity

special olympics

How did you hear about the camp?

Victory Village

Best Buy GSA Website

Inspire Church

Fellowship of Purpose

Unity MBC

Another School or Non-Profit

Disability (FOR ACCOMMODATION)

none

learning/cognitive disability

physical disability

Specify food allergies or special diet

None

Vegetarian

Vegan

No eggs

No nuts

Thanks for submitting!

Email: contact@vvcorp.org ©2024 by VICTORY VILLAGE CORP

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