Youth Registration Form

Youth Summer Retreat Camp Pre-Registration Form 

One time nonrefundable registration fee: $35. 

Payment methods, Venmo or Cashapp: JadeFilmsCo

Please select one of the following question and write a 500 word essay:

1) Why do you think we need more deaf actors on the screen?

2) Who are you and who is your role model?

3) Cell phones have gone from a sought-after luxury to a daily necessity. While these devices provide convenient access to the outside world, they can be problematic for your school teachers. Should cell phone usage be controlled in the classrooms? 

4) If there was a school shooting at your school, what would you do? 

5)  Tell me about why you want to learn about the tv and film industry. What is your dream job in the tv and film industry?

6)  Who is your favorite actor, director or producer? What about their life story or career story inspires you and why?

Email *
Child Name *
Home address  *
City, State & Zip code *
Home phone # (Phone/Text/Videophone/Other) *
Birth date *
Sex *
Pronouns *
Age *
Parents/Guardian's Name *
Emergency contact  *
Relationship to Child *
Email *

If your child have medical/special needs, please list details below:


Any other special needs, requirement or directions that would be helpful for the retreat camp leaders to know about?If your child have medical/special needs, please list details below:


Please indicate which is most accurate ethnic background.


Please check off the programs you’re interested in:


Please check off the recreation activities you’re interested in:

Camp start date *

Retreat fee $750 per youth (13-19) 

Limited partial scholarship will be available for those who qualify. Please email to learn more about the criteria to apply and our cancellation policy.

The lab fee includes lodging, breakfast, lunch, and dinner. This does not include travel to Atlanta. We offer day retreat if you prefer to pick up your child. The fee is $600. Please email us for more information.

Registration fee: $35 (non-refundable)

Final payment by Thursday, June 1, 2023 

Payment Option 1: Venmo: JadeFilmsCo 

Payment Option 2: Cashapp: JadeFilmsCo

Please contact Deaf Talent® Creative Lab™ about applying for a scholarship.

A pre-registration form is not considered complete until all sections are filled out including emergency contact information, demographic information, media release signature and health considerations/food allergy sections.

Deaf Talent® Creative Lab™ will be documenting the summer retreat summer through video and audio recordings and photography. By signing below, I authorize Deaf Talent® Creative Lab™ to use photos, video and audio footage obtained from the retreat camp which may include my child.

I have read and agree to the above policies and I am responsible for registration fee. ______________________________________________ 

Parent/Guardian Signature                          Date

Please submit your pre-registration form to

Please feel fee to email us if you have any questions or concerns. Thank you for filling out the form!

Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy