Highlander Wilderness Adventure Registration Form

Hidden: Registered for Highlander

Personal Information

First Name

Middle Name

Last Name

Gender

Female

Male

Birthdate

Home Phone

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

T-shirt size

Parent/Guardian Information

Please list information for one parent/guardian

First Name

Last Name

Phone Number

Address

Country

Street

City

Region

Postal Code

Emergency Contact Information

Please list information for the person to notify if parent/guardian cannot be reached, in case of emergency

First Name

Last Name

Phone Number

Address

Country

Street

City

Region

Postal Code

Medical Information

I acknowledge that ths course contains elements that may be strenuous, both physically and mentally

Yes

Do you have any health problems which may significantly impact your ability to participate in this program? If you don't have any health problems, please write "None."

Please list any food allergies or specific dietary accommodations. If none, please write "None."

Complete the University Confidential Medical Form and return it by July 15. This form is available for download by the link provided, but a hard copy is also included in your enrollment packet.
The Highlander Adventure Program is geared to persons in average health, but we want to be aware of special health issues which you may have that could cause challenges on the trip. Please be sure to list all potential concerns. For example: allergies, emotional concerns, recent surgeries, etc.

Highlander Wilderness Adventure Deposit Payment

As part of your registration, you are required to pay a $50 deposit. This deposit will go towards your payment for Highlander Wilderness Adventure. Deposits are non-refundable after July 15.

Payment Preference

Pay online from a checkling/savings account or credit card

Pay online through Flywire (for Canadian and International students)

Mail a check to Houghton University

Pay my deposit at a later time (deposit is due no later than July 15)

Pay $50 Deposit:

Amount Due
Transaction Fee	Dependent on selected payment type
Total	Dependent on selected payment type
Loading...

Amount Due

Transaction Fee

Dependent on selected payment type

Total

Dependent on selected payment type

Loading...

Great, you can use this link to pay your $50 deposit via Flywire:

Mail check to:
Student Financial Services
Houghton University
1 Willard Ave
Houghton, NY 14744

In the "Memo" area, indicate the name of the student and Highlander Deposit (example: Highlander Deposit for John Smith).

Highlander Wilderness Adventure Registration Form

Houghton University
1 Willard Avenue
Houghton, NY 14744

+1-800-777-2556
+1-585-567-9200
admission@houghton.edu

©2021 Houghton University. All Rights Reserved. Web Design by Speak