WORLD WITHOUT BORDERS SUMMER ACADEMY OF EXCELLENCE

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Student Name

First Name

Last Name

Students Date of Birth

YYYY

Students Current Grade

Student’s T-Shirt Size:

Name of Student’s School, City and State

Parent or Guardian Name

First Name

Last Name

Parent or Guardian’s Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent or Guardians Home Number

(###)

###

####

Parent or Guardians Cell Number for Text Alerts

(###)

###

####

Parent or Guardian’s Email Address

Please indicate specific subjects challenging your student’s academic success. VGA will add emphasis on the indicated subject area(s).

VGA is a designated Summer Break Spot as part of Volusia County’s Summer Food Service Program. Does the student have any known food allergies? (yes or no):

If yes, please identify

Type "N/A" if not applicable.

The World Without Borders Summer Camp will engage in daily field trips to engage in various aspects of global culture. Examples include cultural restaurants, ethnic museums, international sporting arenas and more. Do you give the above-named student permission to participate in the daily field trips? (yes or no):

Media Release: Do you consent to VGA taking pictures and/ or using your child’s image for student highlights and/or VGA promotions? Yes or No

Signature of Parent or Guardian

I Consent To Registration

I Do Not Consent To Registration, Cancel My Request.