2027 Student Registration Form

Student Name

First NameLast Name

E-mail

example@example.com

Phone Number

Country CodeArea CodePhone Number

Age

Please list your age at the time you be participating in the program.

Will you be using our housing? (Must be 18 years old)

If you are using CMERA housing, please list your gender

Roommate Requests (First and Last Name)

T Shirt Size

How did you hear about our program?

Referred by a Past Attendee? Please list their name below.

Emergency Contact

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

School

Number of Weeks Selected

Weeks Requested:

Payments (Deposits are deducted from the total due and must be submitted with this application to reserve your weeks)

Medical Restrictions

This is used for informational and safety purposes and will not affect your acceptance into the program.