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Highlander Wilderness Adventure Registration Form
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Hidden: Registered for Highlander
Yes
No
Personal Information
First Name
Middle Name
Last Name
Gender
Gender
Female
Male
Birthdate
Birthdate
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Home Phone
Email Address
Mailing Address
Mailing Address
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Street
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Region
Postal Code
T-shirt size
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XXL
Parent/Guardian Information
Please list information for one parent/guardian
First Name
Last Name
Phone Number
Address
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
Address
Country
Street
City
Region
Postal Code
Medical Information
I acknowledge that ths course contains elements that may be strenuous, both physically and mentally
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
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
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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).
Submit
Houghton University
1 Willard Avenue
Houghton, NY 14744
+1-800-777-2556
+1-585-567-9200
admission@houghton.edu
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