VU JAG Summer Academy

Submitted Date

Campus

Major

Email Address

Mobile Phone

First Name

Middle Name

Last Name

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Gender

Ethnicity

Not Hispanic or Latino

Hispanic or Latino

School Information

High School Graduation Date

High School Name

High School CEEB code

High School GPA

JAG Specialist Name

Career Interest

Emergency Contact

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Relationship

Emergency Contact Phone

Emergency Contact Email

Health Information

Medical Conditions

If your student has a food allergy, please contact Laura Carie at events@vinu.edu with the following:
camper name, camp name, and food allergy.

Dietary Restrictions

Other

Which of the following criteria apply to you?

I have been accepted to and plan to attend Vincennes University

I am a current JAG student who is interested in learning more about Vincennes University

I have been accepted to and plan to attend another college or University

Camper Agreements

Youth Code of Conduct

I have read and understand the Youth Code of Conduct

Yes

No

Acceptable Use Agreement for Internet

I have read and understand the Acceptable Use Agreement for Internet

Yes

No

Authorization, Release & Informed Consent Form

I have read and understand the Authorization, Release & Informed Consent Form

Yes

No

Signature:
By typing your name, you have read, understand and agree to the terms of the Vincennes University Pre-College Programs Youth Code of Conduct, the Acceptable Use Agreement for Internet, and the Authorization, Release & Informed Consent Form.

Parental Agreements

Parental Consent

I consent to having my student participate in Vincennes University's JAG Summer Academy.

Photography and Social Media Release:
I assign and grant Vincennes University, and their authorized representatives or agents, the right and permission to use and publish the photographs, film, video, or other electronic or sound recordings made of my child during camp activities. I hereby release Vincennes University, camp coordinators, and all employees, volunteers, and related parties, from any and all liability associated from such use and publication. I further authorize the reproduction, sale, copyright, exhibit, broadcast, storage, and distribution of said media without limitation at the discretion of Vincennes University and I specifically waive any right to compensation I have for any of the aforementioned.

Yes

No

Term

Student Type