Camp Application

 

 


Child's name:
School:
Grade you just completed:
T-Shirt size:
Parent Email:
Parent phone:
Address:
City:
State:
Zip:
Primary Language:
EnglishASLSpanishOther:
Accommodations needed:
ASL interpreterCaptionistBuddy SystemOther:
Age when hearing loss was diagnosed:
Please attach audiogram:
For any sponsorship to be considered, audiogram must accompany application
If applicable, age at which applicant was fitted with hearing aid(s):
If applicable, age at which applicant received cochlear implant(s):
If applicable, age at which ASL was taught:

What other method(s) of communication and educational support service(s) are used in daily communications and educational settings? Check all that apply:

Lip Reading
Sign Language System
(ASL, Signed English, Finger Spelling, etc.)
Cued Speech
Note Taker
Communication Access Real‐time Translation (CART)
Oral Interpreter(s)
Sign Language Interpreter(s)
Auditory Listening Device, such as FM System

Uses sign language with:

Teachers/professorsFriends who are deafFriends with typical hearingOther, please describe:
Preferred Camp:
Deaf CampsMainstreamed CampsDay campOvernight CampPlease find me a camp
Preferred camp: DISCLAIMER: Camps need to be faith-based.


How did you hear about us?
Why should you be selected to attend camp?

Monies will fund camp fees only. All additional expenses will be the responsibility of the parent/guardian.
Approved funds will be distributed directly to the service provider.