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Procedure for application:

1. Fill out online form below 2. Upon receipt of the application, the student will receive a letter to confirm the application status, availability of space, fees and payment methods. The student's space will not be confirmed until his or her fees are paid in full. 3. A deposit of $500 per person is required. The balance of payment is required a month before the camp start date. Contact the camp office at (506) 364-2253 to arrange your payment.
	PAYMENT INFORMATION ** Please ensure that the student’s name is clearly indicated on the payment. a) Cheque or bank draft: payable to Mount Allison University and mailed to:
		Summer program Conference Services 155 Main Street, Sackville, NB, E4L 1B5
	b) Credit Card: Visa or Mastercard
4. An official letter of acceptance will be sent along with the Acceptance Package which will contain all pre-departure information.

Note:
• In the event that a student needs to withdraw prior to the start of camp
    - written notice received one month before the camp starting date; 90% of the fee will be refunded.
     - written notice received one week before the camp starting date; 80 % will be refunded.
    - No fee will be refunded after the camp started
• Camps are conditional upon enrolment. A full refund is issued in the event a camp is cancelled.
• Prices shown are subject to change without notice

	Registration Form


Family Name:		Given Name:
Gender:	Female Male
Date of Birth:		Country of Birth:
Citizenship:		First Language:

Address:

Address:
City:		Province/State:
Postal/Zip Code:
Telephone:		Fax Number:
E-mail:

Parent/Guardian:

Name:		Relationship:
Address (if different from above)
City:		Province/State:
Postal/Zip code:
Home Phone:		Business Phone:
Cell Phone:		Fax Number:

Education:

English proficiency: Excellent Good Fair Poor None
Highest grade completed:

Medical Information:

Do you have any of the following medical conditions which may require special care?

Severe asthma
Life-threatening allergy
Seizure/epilepsy
Diabetes
Other:

Are you on medication? If yes, please specify:



Do you have allergies? If yes, please specify:



Please indicate any special food requirements:



Rules and Regulations:

1. No alcohol or drugs, period.
2. Stay with the group at all times. If I must leave, I will inform a group leader or other authority figure as to my whereabouts.
3. I will not leave the residence, for any reason, after 10:30 p.m. I will respect quiet hours between 10:30 p.m. and 7:30 a.m.
4. I will be respectful of Mount Allison University, the residence and everything belonging to the residence and the other guests staying in the residence.
5. I promise to have fun and learn as much as I can during my experience at MTA.

Student's name (as a sign of agreement):
Date:

Authorization:

I acknowledge all information given is accurate to the best of my knowledge. In permitting my child to attend Mount Allison University summer program, I, the undersigned, permit my child to participate in the full range of activities and authorize the Program Coordinator or his/her appointed, in the event of accident or illness affecting this above named student, to authorize on my behalf all procedures, including admission to hospital and necessary treatment therein, as he or she may deem necessary for the care and well-being of the student. I understand that my child is obliged to abide by the rules and regulations of Mount Allison University and failure to do so may result in suspension from the program without any refund.

Name of parent/guardian (as a sign of agreement):
Date:

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