Corban Experience

Corban Experience Registration Form

Personal Information

First Name

Preferred Name (if different from above)

Last Name

Birthdate

Email Address

Phone Number

Can we text you at this number?

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Sex

Female

Male

I have a friend who is also registering for this event.

Yes

No

What is your friend's name?

Preferred student host (if applicable):

School Information

Which high school do you attend? (If you are homeschooled, choose "*Home School")

High School Graduation Year

What semester are you hoping to start at Corban?

Major

Have you taken any college credits AFTER graduating from high school?

No

Yes

Would you like to request a meeting with an athletic coach?

Yes

No

Which Sport?

Guest Information

How many guests will you be bringing with you?

0

1

2

Guest #1 Information

Guest #1 First Name

Guest #1 Last Name

How is this person connected to you?

Guest #1 Email

Guest #1 Phone Number

Guest #2 Information

Guest #2 First Name

Guest #2 Last Name

How is this person connected to you?

Guest #2 Email

Guest #2 Phone Number

Emergency Contact Information

Emergency Contact

Since this is an overnight event, please provide an emergency contact. This may or may not be a guest that will be attending the event with you.

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Emergency Contact Email

Emergency Contact Relationship to you

Please tell us more:

Allergy Information

Do you or any of your guests have allergies we should be aware of?

Yes

No

Please tell us more about the allergy:

Payment

Corban Experience Payment

Amount Due
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Amount Due

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Agreements

By spending the night on Corban University’s campus, I agree to:

Respect all Corban University residence hall policies, including but not limited to quiet hours, open residence hall hours, and other community life standards.
Respect my host student’s room by keeping it clean and not damaging their space.
Not bring or obtain any product prohibited by Corban University and its Student Life Handbook. I understand that Corban University personnel have the right to confiscate illegal items and/or ask me to leave campus.
Let appropriate Corban University staff contact my emergency contact if the situation demands. This may include but is not limited to a medical or safety emergency.
Not hold Corban University, its staff, and representatives liable for any injuries or medical emergencies that may happen during my stay.

By checking this box and typing your name below, you are signing this agreement electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form

Student Signature

Parent/Legal Guardian Signature

All aspects of this event may be photographed or video recorded. By registering, you are agreeing that any and all photographs or video may be used by Corban University for future marketing purposes.