Healthcare Summer Institute

Camper's School Name

Camp Information

Camper's Shirt Size

Has this camper attended Saint Mary's Summer Programs before?

Please provide the camp name(s) below:

Will this camper possibly be the first in the family to attend college?

Would the camper like to include a roommate request?

Roommates may be requested, but requests must be mutual and listed on all registrations. Summer programs provide double-room occupancy along with a limited number of triple and quad rooms. (All triples and quads are available on a first-come, first-served basis.) If no roommate is requested, one will be assigned.

Preferred Roommate #1

Preferred Roommate #2

Preferred Roommate #3

Would you like to apply for financial assistance for this camp?

Financial Information

In 2024 or 2025, did you, any other parent/guardian of the camper, or anyone in your or the camper's household receive benefits from any of the federal programs listed? Mark all that apply.

Supplemental Security Income (SSI)

Food Stamps

Free or Reduced Price Lunch

Temporary Assistance for Needy Families (TANF)

Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

None of the above

Total number of members in household

Estimated total annual household income

In the section below, please describe what factors are affecting your and your family's ability to contribute to your child's program. Your description should include pertinent family information such as marital status of the camper's parents/guardians, number of children in the family and their ages, significant educational or medical expenses, and any special circumstances we should consider in reviewing this request for financial assistance.

This section must be completed in order to be considered for financial assistance.

Important Information: Submission of this form does not guarantee any financial assistance. Please note that requests for financial assistance are considered on a first come first serve basis.

Do you have a promo code?

Yes

Promo Code

Camp Fee

Early Bird Discount

Amount Due
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Amount Due