Note:
• In the event that a student needs to withdraw prior
to the start of camp, the fees will be returned (less $50
non-refundable deposit) provided the request is received in
writing a week before the camp start date. For cancellation
after the start date, no refund is available.
• Camps are conditional upon enrollment. A full refund
is issued in the event a camp is cancelled. Mount Allison
University reserves all rights to cancel or change the content
of the camp as advertised should unavoidable circumstances
arise.
All fields are required
unless indicated otherwise.
| Personal Data: |
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| Name: |
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| Gender: |
Female
Male |
Age:
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| Date of Birth: |
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First Language: |
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Current School:
(optional) |
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Current Grade: |
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| Address: |
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| Address: |
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| City: |
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Province/State: |
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| Postal/Zip Code: |
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| Telephone: |
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Fax Number: |
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| E-mail: |
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| Parent/Guardian: |
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| Name: |
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Relationship: |
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Address
(if different from above) |
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| City: |
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Province/State: |
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| Postal/Zip code: |
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| Home Phone: |
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Business Phone: |
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| Cell Phone: |
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Fax Number: |
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| T-shirt size: |
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Any experience with the selected language?
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Yes (For how long:
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No |
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| Any elements of the language or culture that
are of special interest to you? |
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| How did you hear about our programs? |
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| Medical Information: |
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| 1. Do you have any of the following medical
conditions which will require special care? |
Severe Asthma
Seizure/epilepsy
Diabetes
Other - please specify:
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| 2. Are you on any medication? If yes, please
specify: |
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| 3. Do you have any life threatening or non-life
threatening allergies? If yes, please specify: |
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| 4. Please indicate any additional health issues
that the group leaders should be aware of. |
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| 5. Please indicate any special food requirements. |
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| Rules and Commitments
for Students: |
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1.
No alcohol, drugs or sex.
2. Campers will stay with the group at
all times. Campers will inform their group leader or other
authority figures if they must leave.
3. Campers will not leave the residence,
for any reason, after 10:30 p.m. Campers will respect quiet
hours between 10:30 p.m. and 7:30 a.m. and stay in their
own room to sleep during this time.
4. Campers will be respectful of Mount
Allison University property and other guests staying in
the residence.
5. Campers are expected to clean up after
themselves and keep their living and eating areas tidy.
6. Males and females are to remain in separate
rooms at night, unless an alternative arrangement is accepted
by a group leader.
7. This is a complete immersion program.
Campers will make an effort to speak in the selected language
during the week.
I have read carefully the above rules and commitments,
and agree to adhere to them, and to contribute to a safe
and positive environment for all campers.
Date:
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| Authorization: |
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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. |
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| Name of parent/guardian (as a sign
of agreement): |
| Date: |
