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Part One: General Information
*
Indicates required field
1. Name
*
2. WeChat ID:
*
3. Phone Number
*
4. Which program are you part of this Summer?
*
NASA
Road to Harvard
ALCI
NC/Xin Hang Dao
Summer S.T.E.A.M. Camp at Cheshire Academy
Angli California School Exchange
Other
5. Do you have availability in August or any possible auxiliary programs?
*
Yes
No
Not Sure
Depends on When
If "Other," please specify
*
If "Depends on when," please specify:
*
6. Do you have any dietary restrictions?
*
7. Allergies?
*
8. Any medical conditions you would like the program director to be aware of?
*
9. Among the students, do you have an age group you'd feel most comfortable working with?
*
I have no preference
Lower Range (9-11 years old)
Mid Range (12-14 years old)
Oldest Range (15-17 years old)
Part Two: Emergency Contact Information
In the unlikely event of an emergency during the program, please provide the information for at least one emergency contact. Your emergency contact does not need to be a family member, but they should be:
Someone you trust
Actively responsive to phone and email
Aware of any medical concerns you may have
10. Emergency Contact Name
*
12. Emergency Contact Email
*
11. Emergency Contact Phone
*
13. Emergency Contact Relationship to You
*
If you would like to add a second emergency contact, you may use questions 14-17 to do so:
14. Emergency Contact Name
*
16. Emergency Contact Email
*
15. Emergency Contact Phone
*
17. Emergency Contact Relationship to You
*
Part Three: Bank Information
18. Bank Name
*
19. Routing Number
*
20. Account Number
*
21. Type of Account
*
Checking
Savings
Other
If "Other," please specify
*
22. Home Address Associated With This Account
*
Line 1
Line 2
City
State
Zip Code
Country
Part Four: Photo Waiver
Check the box:
*
I hereby grant permission to Boston Roundtable to use photographs and/or video of me taken during the duration of my program session in publications, news releases, online, and in other communications related to the educational mission of Boston Roundtable.
Photos will only be used in official Boston Roundtable outreach material to promote visibility of our travel programs. Boston Roundtable will NEVER use photos to deliberately portray staff in a negative light.
Any additional comments?
*
Submit
Home
News
About Us
Roundtable Blog
Work With Us
>
Jobs
Year-Round Opportunities
Coronavirus
Services
Online Curriculum
>
Emerging Leaders
ABC
4-5th grade Language Arts
6-8th grade Writing
9-11th grade English
Educational Camps
>
About Our Camps
>
Camp Overview
Our Counselors
Camp Proposals (游学项目 )
Traveling Camps
>
College Exploratory Camp
NASA Space Camp
West Coast Basketball Camp
Band Festival Camp
Residential Camps
>
ALCI in Boston
West Coast Exchange
Study Abroad & Advising
>
For Students
Become an Advisor
Teach Abroad
>
For Teachers
>
Overview and Application Process
Teach Abroad FAQ
>
Where We Send Our Teachers
Current Opportunities
Apply Now!
For Overseas Partners
Contact
中文