West Virginia Wesleyan College Summer Gifted Program
Registration Form
Name
*
First Name
Last Name
Parent/Guardian Name
*
First Name
Last Name
Additional Parent/Guardian Name
*
First Name
Last Name
Name of School
*
Grade level for next school year
*
Name of achievement test or other assessment method
*
Test scores (percentile in verbal or math)
*
Email
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birth date:
*
-
Month
-
Day
Year
Date
Will your student be a residential or day camper?
*
Residential (stay in residence hall and eat all meals on campus)
Day camper (Spend nights at home but eat some meals on campus)
Gender:
*
If your student is a day camper, which meals will they eat on campus?
*
Breakfast
Lunch
Dinner
None, my student will bring a packed lunch and dinner each day.
How long will your student attend?
*
Both weeks
Week 1
Week 2
Your student's size (enter adult or child and S/M/L/XL etc.)
Submit
Should be Empty: