Southeast Missouri State University

Participant Name: (Required)

Last Name:

First Name:

Mailing Address: (Required)

Street:

City:

State:

Zip Code:

Date of Birth: (Required)

Home Phone: (Required)

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Cell Phone: (Required)

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Email Address: (Required)

Gender: (Required)

Male

Female

School: (Required)

Parent/Guardian Name: (Required)

Last Name:

First Name:

Parent/Guardian Home Phone: (Required)

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Parent/Guardian Cell Phone: (Required)

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Parent/Guardian Email Address: (Required)

Camp: (Required)

Emergency Contact Information: (Required)

Name:

Phone:

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Relationship:

Special Needs and Accommodation (Medical/Allergies/Dietary Issues):

Cancellation Policy:
In the event that the University would need to cancel your designated camp a full refund will be returned back to participant and/or family in the form of a University check. In the event that you the participant and/or family will need to cancel your registration, you will receive a full refund up until 4 weeks from the camp. If you cancel within 4 weeks of the camp you will receive a partial refund. Partial Refund is a $50 loss from your camp registrations cost. Registration cancellations made within 5 business days of start date will not be eligible for a refund.

**Partial Refund is a $50 loss from your camp registrations cost.

There are no workshops available for sign up.

Southeast Missouri State University

Registration Form