Summer Intensive Residence & Meal Plan 2023

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Summer Intensive Residence and Meal Plan 2023 Form

Resident Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Student Email [primary contact]*
Parent/Student Phone [primary contact]*
Health Information
Health Card Number:*
Province where health card was issued:*
Insurance Company:
Policy Carrier
Policy Number:
Please list any and all allergies - if you have none please write N/A:*
Are you taking any medication(s)? If yes, please list and indicate if student needs help with administration. If no, please write down N/A*
Do you have any injuries? If so please list and explain. If not, please write N/A:*
Emergency Contact Information
If the student is under 18 years, at least one emergency contact must be a parent or guardian.
Emergency Contact #1 Name*
Emergency Contact #1 Relationship*
Emergency Contact #1 Phone Number*
Emergency Contact # 1 Email*
Emergency Contact # 2 Name*
Emergency Contact # 2 Relationship*
Emergency Contact # 2 Phone Number*
Emergency Contact # 2 Email*
RESIDENCE
Note: Check-in is any time after 4:00pm and Check-out is 11:00am.
Select the sessions that you are staying in residence*
- June 25-July 23 (4 weeks JC)
- June 18-July 30 (6 weeks JC)
- July 2-July 8 (1 week SUM IV)
- July 2 -July 22 (3 weeks SUM IV)
- July 2-August 5 (5 weeks SUM IV)
- August 7 -August 13 (SUM II-III Week 1)
- August 13 -August 19 (SUM II Week 2)
- August 7-August 19 (SUM II-III Both Weeks)
Is there a resident with whom you would like to share a room? Please list the name below. Note: This request will only be considered if the other resident also requests to share with you.

Note: Each floor is made up of single and double rooms.
Meals
Dine-in breakfast is included in your residence fee. Dine-in Dinner is available and can be included in your residence fee, depending on your selection. Bagged lunches can be purchased separately.
Will you require dine-in dinner?*
- Yes
- No
Dinner can be included in your residence fees.
Will you be purchasing bagged lunches?*
- Yes
- No
Bagged lunches are separate from residence fees and are purchased individually.
Please list any allergies or dietary restrictions that we need to be aware of.*
Do you anticipate needing the Airport Pick-up/Drop-off service?
- Yes
- No
- Maybe

Summer Intensive Residence and Meal Plan 2023 Form

Resident Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Student Email [primary contact]*
Parent/Student Phone [primary contact]*
Health Information
Health Card Number:*
Province where health card was issued:*
Insurance Company:
Policy Carrier
Policy Number:
Please list any and all allergies - if you have none please write N/A:*
Are you taking any medication(s)? If yes, please list and indicate if student needs help with administration. If no, please write down N/A*
Do you have any injuries? If so please list and explain. If not, please write N/A:*
Emergency Contact Information
If the student is under 18 years, at least one emergency contact must be a parent or guardian.
Emergency Contact #1 Name*
Emergency Contact #1 Relationship*
Emergency Contact #1 Phone Number*
Emergency Contact # 1 Email*
Emergency Contact # 2 Name*
Emergency Contact # 2 Relationship*
Emergency Contact # 2 Phone Number*
Emergency Contact # 2 Email*
RESIDENCE
Note: Check-in is any time after 4:00pm and Check-out is 11:00am.
Select the sessions that you are staying in residence*
- June 25-July 23 (4 weeks JC)
- June 18-July 30 (6 weeks JC)
- July 2-July 8 (1 week SUM IV)
- July 2 -July 22 (3 weeks SUM IV)
- July 2-August 5 (5 weeks SUM IV)
- August 7 -August 13 (SUM II-III Week 1)
- August 13 -August 19 (SUM II Week 2)
- August 7-August 19 (SUM II-III Both Weeks)
Is there a resident with whom you would like to share a room? Please list the name below. Note: This request will only be considered if the other resident also requests to share with you.

Note: Each floor is made up of single and double rooms.
Meals
Dine-in breakfast is included in your residence fee. Dine-in Dinner is available and can be included in your residence fee, depending on your selection. Bagged lunches can be purchased separately.
Will you require dine-in dinner?*
- Yes
- No
Dinner can be included in your residence fees.
Will you be purchasing bagged lunches?*
- Yes
- No
Bagged lunches are separate from residence fees and are purchased individually.
Please list any allergies or dietary restrictions that we need to be aware of.*
Do you anticipate needing the Airport Pick-up/Drop-off service?
- Yes
- No
- Maybe

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Summer Intensive Residence and Meal Plan 2023 Form

Health Information

Emergency Contact Information

RESIDENCE

Meals

Summer Intensive Residence and Meal Plan 2023 Form

Health Information

Emergency Contact Information

RESIDENCE

Meals