Horizons: Register using the online registration form or you may print and mail or fax this form

Note: After submitting your online registration form, call us at (573) 986-6879 with your credit card payment information or mail us a check to complete your registration. Registration is not complete until payment is received.
Registration Options
Register using the online registration form or you may print and mail or fax a registration form. Must be 18 years of age to register a Horizons participant.

Pre-registration
Pre-registration and prepayment are required for all courses.

General Information
Click here for general information regarding Horizons programs.

Please complete all fields of this form. (* Required Information)

Participant Information

First Name*     MI     Last Name*

Child's Birthday (i.e. 06/26/96)* Male    Female

Street Address:*

City:*        State:* Zip:*

Day Telephone:*     Evening Telephone:

T-Shirt:
Child      Adult
T-Shirt Size:
Small      Medium     Large     X-Large     XX - Large

Parent/Guardian Information

Parent/Guardian Name:

Day Time Phone:

Emergency Contact Name:

Emergency Contact Number:

Class Information

Listed below are Horizons courses offered through the Office of Continuing Education. On-line registration is available for all Continuing Education Horizons Courses.

Course Name:(*To choose more than one course hold down the CTRL key)

Little Horizons (ages 5-8)

Session Four - June 23-27

Lunch Supervision/Pick-up (available only if enrolled in both an AM and PM session during the same week. Lunch will not be provided; child must bring his/her own sack lunch.)

Payment Method

Credit Card (you will be contacted by phone for your credit card information)

Check (Submit this form and send payment to address below.)

Have you read and do you understand the Cancellation and Refund Policy?

Yes, I have read the Cancellation and
             Refund Policy* No, I do not agree with Policy

How old are you? (Optional)

What is your gender? (Optional)

18 - 20      21 - 24    25 - 34
35 - 44      45 - 54    55 - 64
65+ Male    Female

I understand that after submitting this form I will receive confirmation that my form has been received in the Office of Continuing Education and does not guarantee my enrollment. Upon payment, I understand that I will receive an official enrollment confirmation by mail from Continuing Education.

Mailing Address:
Southeast Missouri State University
Office of Continuing Education
One University Plaza, MS6850
Cape Girardeau, Missouri 63701

Fax #: (573-986-6883) -- open 24 hours

If you have any problems filling out the on-line registration form, please contact the Office of Continuing Education at 573-986-6879 or e-mail coned@semo.edu.

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Extended & Continuing Education
Horizons Home General Info Registration

Contact webmaster: Krista Mayfield, Program Technician

This page was last updated June 18, 2008 .