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Pharmacy Summer Camp RSVP
Header 1
The sixth annual 2013 pharmacy summer camp will take place on two different dates in June. It is only open to high school students who will become juniors or seniors in the fall of 2013.
Pharmacy Summer Camp 2013 RSVP
Camp Date Preference
*
Camp Date Preference
June 12-14 (Wed, Thurs, Fri)
June 24-26 (Mon, Tue, Wed)
Camper Information
Male or Female
*
Male or Female
Male
Female
First Name
*
Middle Initial
*
Last Name
*
Name On Your Name Tag?
*
Street Address
*
Address (2)
City
*
State
*
ZIP
*
Home Phone
*
Cell Phone
*
Email
*
Age
*
Date Of Birth
*
Current High School
*
High School Graduation Year
*
T-Shirt Size
*
Please Select ...
Small
Medium
Large
XL
2XL
3XL
Emergency Contact #1
Full Name
*
Relationship To The Student
*
Their Cell Phone
*
Their Home Phone
*
Emergency Contact #2
Full Name
*
Relationship To The Student
*
Their Cell Phone
*
Their Home Phone
*
Camper-Specific Information
Any special dietary needs, e.g. vegetarian, gluten-free, food allergies, etc
*
Any special dietary needs, e.g. vegetarian, gluten-free, food allergies, etc
Yes
No
Please list them here:
*
Do you have any allergies?
*
Do you have any allergies?
Yes
No
Please list them here:
*
Are you taking any medication?
*
Are you taking any medication?
Yes
No
Please list them here:
*
Any other needs we should know about?
*
Any other needs we should know about?
Yes
No
Please list them here:
*
Camper Education Information
Current GPA (based on a 4.0 scale)
List any pharmacy related courses taken since the beginning of high school (indicate if honors, AP or IB class)
List any extracurricular activities
Why you are attending this camp?
*
What you hope to gain from this experience?
*
Payment
The 2013 Pharmacy Summer Camp cost is $300
Amount to be charged to your card
$
Cardholders Full Name
*
Type of Card
*
Please Select ...
VISA
Mastercard
Discover
American Express
Credit Card Number
*
Expiration Date
*
3 or 4 Digit Code (back of card)
*
Pharmacy Camp Terms and Conditions
The University of Findlay College of Pharmacy Summer Camp will not tolerate acts of vandalism, fighting, substance abuse, curfew violations, or any other violations of camp and University safety regulations. No weapons of any kind (knives, guns etc.) are permitted nor will be tolerated. In the event a student is expelled from the camp, a refund will NOT be issued. The camp will reserve the right to expel a student on these or any grounds necessary.
By clicking the "Submit" button you agree to have answered everything honestly and agree to follow the above terms and conditions and most importantly to have fun at camp!
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