Deaf & Hard of Hearing Connections Week 2019 Registration Form

Registration Deadline: Friday, March 1, 2019
Please complete this form for each student you are registering.
Main Contact is the Teacher of the Deaf and Hard of Hearing who will be accompanying students.
If there is no TDHH associated with the student, the student's accompanying adult (e.g. interpreter, EA, SEA, Social Worker) is the main contact. The parent may be the main contact if the student is home schooled.
Main Contact (MC) - First and Last Name *
Your answer
Main Contact (MC) - DOB *
Needed for air travel information.
MM
/
DD
/
YYYY
MC - Email address *
Please double check for typos as your email will be used to send you a confirmation of your registration.
Your answer
MC - Position
MC - Cell Phone number
Your answer
Additional Adult - First and Last Name
Your answer
Additional Adult - DOB
Needed for air travel information.
MM
/
DD
/
YYYY
Additional Adult Email
Please double check for typos as your email will be used to send you a confirmation of your registration.
Your answer
Additional Adult - Position
Additional Adult - Cell Phone Number
Your answer
Student's Name *
Your answer
Student's DOB *
MM
/
DD
/
YYYY
Student's grade level *
Student - Communication needs *
Required
Optimist Day April 15 - Student will be: *
Student will compete in this category *
Education Day April 16 - Student will participate *
Friendship Day April 17 - Student will participate *
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