Victory Academy Fall 2025 - Spring 2026 Registration Form

VICTORY ACADEMY FALL 2025 Registration

Every 3rd Saturday in September 2025 - May 2026 Students who attend the Fall - Spring Sessions receive priority registration for Spring Break and Summer Camps!
Student's Information
Student 1 Name

First NameLast Name
Student 1 Birth Date

MonthDayYear
Student 1 Grade
Student 2 Name

First NameLast Name
Student 2 Birth Date

MonthDayYear
Student 2 Grade
Student 2 Gender

MaleFemale
Student 3 Name

First NameLast Name
Student 3 Birth Date

MonthDayYear
Student 3 Grade
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the student(s) have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the student(s) prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Victory Academy during the selected camp. In exchange for the acceptance of said child’s candidacy by Victory Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Victory Academy and Victory Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Victory Academy, Victory Church including all staff, officers, teachers, affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Victory Academy during the selected camp. In exchange for the acceptance of said child’s candidacy by Victory Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Victory Academy and Victory Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Victory Academy, Victory Church including all staff, officers, teachers, affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

VICTORY ACADEMY FALL 2025 Registration

Student's Information