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Student Information

First Name     Last Name

Street or P. O. Address

City   State   Zip

Sex: Female Male

T-Shirt Size:

Area Code and Home Phone Number


Parent Name Parent Phone

School Information


Street or P. O. Address

City   State   Zip



2013-2014 Staff Position   

2014-2015 Staff Position

Total number of years on staff:

Lodging Options

Commuter ($0)
Quad Occupancy ($120)
Triple Occupancy ($160)
Double Occupancy ($225)
Single Occupancy ($425)

Class Registration

Student 1st choice Student 2nd choice

Roommate Information

Roommate 1

Roommate 2

Roommate 3