Deaf & Hard of Hearing Connections Week 2019 Registration Form
* Required
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
TDHH
EA/SEA/IV
Interpreter
Other:
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
TDHH
EA/SEA/IV
Interpreter
Other:
Additional Adult - Cell Phone Number
Your answer
Student's Name
*
Your answer
Student's DOB
*
MM
/
DD
/
YYYY
Student's grade level
*
Choose
K
1
2
3
4
5
6
7
8
9
10
11
12
Student - Communication needs
*
ASL user
Oral communication method
Uses both ASL and spoken English (Oral)
Needs FM/DM access at events
Required
Optimist Day April 15 - Student will be:
*
Competing in the Optimist contest
Observing the Optimist contest
Student will compete in this category
*
Choose
ASL
Oral (spoken)
None - observing only
Education Day April 16 - Student will participate
*
Choose
Yes
No
Friendship Day April 17 - Student will participate
*
Choose
Yes
No
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