Please Select:  Resident Commuter

Camp:  2-Week CX (July 18-July 31) 3-Week CX (July 11-July 31) 1-Week MS (July 19-July 23 Commuter Only)

First Name

Last Name

Date of Birth Sex Female Male

email

Home Address:
 
 
City State Zip

Home Phone:    Home Phone 2 (not required)

Parent/Guardian Name(s) Phone:  Day Evening

Parent/Guardian Name(s) Phone:  Day Evening

Medical Information

Health Insurance Provider
Insurance Policy Number Social Security # 
Physician Name  Contact
Known Health Conditions/Medication:

Emergency Contact Information

Contact Name(s) Relation
Phone Daytime  Evening

Secondary Contact (not required) Name Relation
Phone Daytime  Evening

Debate Information

School:  Year in School in 20010-2011 (Upcoming School Year): 6th 7th 8th 9th 10th 11th 12th

Coach:  Phone email

Partner Request: 

Roommate Request (Residents Only): 

Usual Speaker Positions:    Competition Level: 
Year Competed: 

Please list any awards or accomplishments that you have received in debate/Student Congress competition:

Please indicate which of these arguments you regularly run in debate rounds:

Topicality
Disadvantages
Critiques
Counterplans

Please list your goals for the UMKC Summer Debate Institute:

UMKC offers college credit for your work at the UMKC SDI for a discounted fee per hour of college credit.  Each student in the 2 and 3-week HS camps will receive 1 credit of UMKC College Credit included in their tuition.  If you are interested in 2 more hours, please indicate that below.

I am interested in 2 additional hours of college credit.

Please let us know how you heard about UMKC Summer Debate Institute (check all that apply):

UMKC Debater/Coach
School Mailing/Flier
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Past Attendee
I have previously attended
Other Please Describe