Champlain College

Champlain College
Summer Launch

Interested in the Summer Launch Ultimate Transition Experience?

You must call or email Skip Harris (802) 651-5961, sharris@champlain.edu or Luke Lewis (802) 651-5959 llewis@champlain.edu to discuss the logistics of this program prior to registering for the Summer Launch Ultimate Transition Experience.

Summer Launch Options:

$200 – Roller Coaster Extravaganza:
                  Friday, June 21 - Sunday, June 23

$200 – Outdoor Adventure Program:
                  Monday, July 1 - Wednesday, July 3

$200 – Community Service in Montreal:
                  Tuesday, July 16 - Thursday, July 18

(* indicates required fields)

First Name*         MI
Last Name*
Gender* Male    Female
Address 1*
Address 2
City*
State, Province
or Region*
Country*
Zip Code*
Phone Number*
E-mail* (only used for confirmation purposes)
T-shirt Size

Small 
Medium
Large
XL
XXL 
XXXL

Emergency Contact Information:

Name*
Relationship*
Phone Number*
 

Additional Information:

You MUST answer each of these quesitons even if the answer is 'No.'

Do you have any dietary restrictions?
List any major injuries you have had in the last five years.
Please list any allergies you have (you will need to bring the appropriate medication).
Are you currently taking any other medications? If so, please list.
Do you have any condition that we should be aware of?

Total:

$    


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