Summer ESL and Cultural Program

**A Typical Day**
8:30	Breakfast
9:00	Classes
12:00	Lunch
1:00	Conversation Practice
2:00	Activity/Excursion/Workshop
5:00	Dinner
6:00	Evening Social Event
	Weekend Campout!

Luther College Summer ESL and Cultural Program 2016

Name On Passport*

Birthdate
(DD-MM-YYYY)*

Gender*

Citizenship of Student*

Student Email Address

Mailing Address

Address Line 1*

Address Line 2

City*

Province*

Country*

Postal Code*

School Currently Attending*

School Planning to Attend*

How did you hear about our summer program?

Website

Agent

Friend

School

Other

Parent / Guardian Contact Information

Name*

Home Phone*

Emergency Phone*

Email Address

Employer

Guardian Contact in Regina

Name*

Home Phone*

Emergency Phone*

Email Address

Select program payment

Students living in Regina who don't require room and board ($1,890.00)

Students who are not currently living in Regina who require room and board (in residence) ($2,100.00)

Permission

I understand that Luther College reserves the right to cancel or modify any part of the summer ESL program for any reason

I understand that Luther College reserves the right to remove and send home any participant whose behavior is disrupting the learning environment, interfering with the smooth operation of the program or adversely affecting the enjoyment or safety of other participants. If a participant has to be sent home for disciplinary reasons, the parents will be required to pay for any and all costs incurred, and will forfeit all program fees.

I give permission for the official in charge to make arrangements for medical attention if so needed in the event of an emergency without my prior approval. I understand that I will be notified by the quickest means possible in case of an emergency. I understand that as parents, we will be responsible for all medical costs incurred. I also understand that it is my sole responsibility to arrange for additional traveler's medical insurance for my child for the duration of the summer ESL program.

I give permission to the official in charge to sign a waiver form for my child if required for program activities that are offered by non-Luther controlled organizations. I understand and permit that my child may have his or her photograph taken and these photographs may be used in advertising or other purposes by Luther College High School (for example in brochures or the website)

Credit Card Information

Credit Card Number*

CV Code*

Expiry Month*

Expiry Year*

Name*

Address Line 1*

Address Line 2

City*

Province*

Country*

Postal Code*

Phone Number*

Email*

Click here to proceed with payment.

Summer ESL and Cultural Program

Summer ESL and Cultural Program

Make new friends! Have fun! Improve your English before school starts!

Immerse yourself in Regina's culture! Enjoy the great outdoors!