Summer Game Design Camps Registration Form

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740.351.3390 |
740.351.3018
Phone
Fax
940 Second Street | Portsmouth, OH 45662
SUMMER GAME DESIGN CAMPS REGISTRATION FORM: QUESTIONS? PLEASE CALL DEBBIE: 740.351.3390
WAYS TO REGISTER FOR CAMP:
Online at:
Mail: Shawnee State University Gaming Day Camps, ECS, 940 Second Street, Portsmouth OH 45662-4344
Email: dschwamberge@shawnee.edu
Phone: 740.351.3390 or 740.351.3377
Fax: 740.351.3018
In person: Our office is open M-F, 8 am – 5 pm. We are located in the Morris University Center, Morris University Center Ketter Conference Room, Ste 219
Please complete this form and choose a Payment Option below. Please print legibly. Thank you, Events & Conference Services
Child’s First Name _______________________________________ MI__________ Last Name___________________________________________________ Age_________
Cell Phone ________________________________________________________ Home Phone_______________________________________________________________
E-mail ______________________________________________________________ School_______________________________________________________________
Home Address ___________________________________________________________ City________________________________ State________________Zip_________
Emergency Contact _________________________________________ Emergency Contact Phone Number __________________________________________________________
Special Needs of Participant (Accessibility, dietary, etc.) __________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
I AM REGISTERING FOR:
o $175
GAME PROGRAMMING CAMP
Monday-Friday
July 11-15
9 am-3 pm
Lunch included
GAME ART+DESIGN CAMP
o $175
Monday-Thursday July 11-14
9 am-4 pm
Lunch included
$
Total
SUMMER GAME DESIGN CAMPS PAYMENT OPTIONS:
o CASH
o CHECK / MONEY ORDER
o CREDIT CARD*
1
Register in person: Morris University Center
Mail a check/money order, payable to Shawnee State
Register in person: Morris University Center
Ketter Conference Room, Ste 219
University, with your completed form to:
Ketter Conference Room, Ste 219
Monday–Friday | 8am–5pm
Monday–Friday | 8am–5pm
Office of Event & Conference Services
Shawnee State University
Or by calling Debbie: 740.351.3390
Cash must be hand-delivered
1
940 2nd Street, Portsmouth OH 45662
(Credit card only)
*Credit Card Information: Discover / Visa / MC (Circle one and complete the information below.)
Credit Card # _________________________________________________________________________ Exp. Date_______________________________CSV #_________
Name As It Appears On Credit Card _____________________________________________________________________________ Amount $___________________________
Cardholder’s Mailing Address _________________________________________________ City________________________________ State________________Zip_________
Policy regarding payment by credit card. Credit card transactions are processed on the day they are received. Charges in excess of the credit card limit or otherwise invalid transaction will result in an incomplete registration, and the cardholder will be notified immediately.
Until adequate payment is provided, including additional fees consistent with current university policies, the registration will be incomplete. If a refund is due, it will be issued in the form of a check payable directly to the cardholder. I agree to pay the sum set forth above to
the credit institution which issued my card in accordance with the terms of the credit card for the purchase of goods and services. I do agree to the policy as stated above regarding payment by credit card.
Cardholder’s Signature ________________________________________________________________________________________ Date___________________________
Course Cancellations: The Office of Event & Conference Services will make every effort to maintain the scheduled day camps. However, events such as instructor illness or insufficient enrollment may
require a schedule adjustment or cancellation. We will notify participants of any course changes, and issue a full refund for course cancellation.
Refund Policy: Students withdrawing from a class at least three full business days prior to the start date of a class will receive a full refund minus a 10% processing fee. No other refunds will be granted.

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