13th annual Envisioning Youth Empowerment (EYE) Retreat Parent and Participant Application
BASIC INFORMATION ABOUT THE EYE RETREAT:
Who: Youth with visual impairments who want to learn about college and careers.
What: A day seminar that provides an opportunity for mentoring and resource sharing by current college students and workers with visual impairments.
When: Saturday, November 13, 2021
Where: Columbus Metropolitan Library Southeast Branch 3980 S Hamilton Rd, Groveport, OH 43125
4. Sports and Recreation
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Name of Student (first and last)
Address (street, city, state, and zip code)
Who is attending?
Our college track includes a mock college course. Our careers track include job shadowing opportunities.
Student and Parent
Name of Parent (if attending):
What is your home phone number?
What is your cell phone number?
What is your email address?
Currently, I am:
A Graduate Seeking Employment
I consider myself to be:
Do you have any medical conditions besides blindness (be specific)?
Do you have any food allergies or restrictions (be specific)?
Do you require any other accommodations in order to participate (be specific)?
How do you access printed materials?
In one sentence, tell us why you wish to attend the EYE Retreat?
Besides one day mini EYE Retreats, we host an annual week long summer camp each July in North Carolina. Are you interested in learning more?
Please provide contact information for a family member or friend in the event of an emergency.
Name, phone number(s), and relationship to you.
Is all the information you have provided on this form true and accurate?
Print YOUR name here indicating you are submitting this application with true and accurate information.
PARENTS/GUARDIANS: If the participant is under the age of 18, Print YOUR name here indicating you give permission for your son/daughter to participate and that you are submitting this application with true and accurate information.
The EYE Retreat is a 501c3 nonprofit organization. Its Board of Directors has developed a policy manual and other forms. They are available at
By submitting this application, you agree to adhere to the EYE Retreat policy manual. Further, you agree to a waiver of liability against the EYE Retreat and its volunteers and officers in connection with participating in the EYE Retreat.
Yes, I agree.
No, I do not agree.
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