Fillable SUMMER LEARNING RegistraonForm FOR OFFICE USE ONLY (East Central College)

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SUMMER LEARNING RegistraonForm FOR OFFICE USE ONLY (East Central College)

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The SUMMER LEARNING RegistraonForm FOR OFFICE USE ONLY (East Central College) form is 1 page long and contains:

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  • 4 check-boxes
  • 45 other fields

Country of origin: US
File type: PDF

U.S.A. forms for East Central College

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Name: __________________________________________________________________________________________
(First) (MiddleInial) (Last)
Date of Birth: ______________ Male Female Email: ____________________________________________
Address: ______________________________________ City: __________________ State: ______ Zip: _____________
Parent/GuardianContactInformaon:____________________________________________
Parent Guardian
Primary Phone: ( _______ ) _________________________ Secondary Phone: ( _______ ) _________________________
IgrantEastCentralCollegepermissiontousethephotographsoftheabovemenonedchild,__________________,in
publicitymaterials,including,butnotlimitedto,itswebsites.
Parent or Guardian’s Signature: _____________________________________ Date: ________________
How did you hear about ECC Summer Camps? __________________________________________________________
RegistraonForm
FOR OFFICE USE ONLY
Student ID:
_________________________
RegistraonDate:
_________________________
Registered By:
_________________________
Semester Subject Course # Secon Title Day/Time Fee
CE $
CE $
CE $
CE $
Total: $
Fees are due at the me of registraon to secure your place in class.
Registraonpaidbycheck
(makepayabletoEastCentralCollege)
Check#:____________________________________
Registraonpaidbycash
(onlyacceptedattheCommunityEducaonoceinUnion)
Amount: $ ___________ Received By: ____________
Refund/Withdrawal Policy
Occasionally,classesmayberescheduled,consolidatedorcanceledatthediscreonofEastCentralCollegeCommunityEducaon.IntheeventofaclasscancelaonbyEastCentralCollegeCommunityEducaon,eachstudentwillbeprovidedafullrefund.To
withdraw,studentsmustcontactEastCentralCollegeCommunityEducaonnolessthan48hourspriortothestartoftheclass.Studentsthatwithdrawlessthan48hourspriortothestartofclassshallforfeittheirrighttoarefund.Allregistraonsincludea$5.00
nonrefundableregistraonfee.Someprogramsmayhavespecicpolicieswhichwillbenotedinindividualclassdescripons.Locaons,datesandmesaresubjecttochange,butparcipantswillbenoed.EastCentralCollegedoesnotdiscriminateonthebasis
ofrace,color,religion,naonalorigin,ancestry,gender,sexualorientaon,age,disability,genecinformaonorveteranstatus.Inquiries/concernsregardingcivilrightscomplianceasitrelatestostudentprogramsandservicesmaybedirectedtoShelliAllen,Vice
PresidentofStudentDevelopment,131BuescherHall,1964PrairieDellRoad,Union,MO63084,(636)584-6565orstnoce@eastcentral.edu.
SUMMER LEARNING
ACADEMY
Email/Mail to:
East Central CollegeAn:CommunityEducaon
1964PrairieDellRoad•Union,MO63084
ce@eastcentral.edu
By Phone/Fax:
Phone:636.649.5803
Fax:636.584.8988
In Person:
East Central College
Business & Industry Center
42PrairieDellPlazaDrive•Union,MO63084
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SUMMER LEARNING RegistraonForm FOR OFFICE USE ONLY (East Central College)

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Completed 26 July 2020

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