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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
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
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
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
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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