Summer Excellence Camps Registration Form

Contact Information

Name:

Male     Female

Age:   Grade in Fall '08:   Phone:

Address:

City, State, ZIP Code:

E-mail Address:

Parents' Daytime Phone:

School:

Roommate:
(List only one person. Request must appear on both campers' forms.)

I understand that any camper who does not abide by the rules and regulations of the camp is subject to dismissal without reimbursement. I authorize the directors of the camp to act for me, according to their best judgement, in any emergency requiring medical attention. Any medical bills will be billed first to the parents' primary insurance plan.

Parent/Guardian Signature:
(By typing your name in this box, you acknowledge that you have read and agree to the above paragraph regarding camper dismissal and medical emergencies.)

Parents' Health Insurance Company and Policy Number:

Select the one camp you wish to attend:

President's Institute for Student Leadership*
Math Camp
Art Camp
Media Geek Camp
Piano Camp
Inventor's Camp

* The Institute is intended for high-achieving high school juniors and seniors. A limited number of sophomores may be admitted as space allows. Acceptance to the Institute will be selective and further application materials including and application essay may be requested. For more information, visit houghton.edu/camps.

Register early for greatest discounts

NOTE: Lab Fee and Early Registration Discount are filled in automatically, and the Balance is automatically calculated.

Camp cost:	Resident Camper	$330.00
	Day Camper (meals not included)	$220.00
Lab fees: The following camps have an additional lab fee that must be added to the total cost.	Art Camp	$75.00
	Media Geek Camp	$75.00
	Piano Camp	$110.00
Discounts: Both discounts may apply if conditions are met.	Registration received by May 1	$-25.00
	If you have five from the same school and the registration is received by May 1	$-20.00
Deposit:	Due with registration form		$-50.00
Balance:	Due at camp		$

Submit Please click only once!