We're Worth It: Deaf Youth Summer Program Registration
If you would like to fill out this form in ASL please contact Danielle, Youth Services Coordinator:
VP: 510-343-5167
Email: danielle.silk@dcara.org
Contact Danielle To Register in ASL
What is your name? *
What is your address? *
What is your email address? *
What is your date of birth? (This program is open for youth between the ages of 16-21.) *
What is your VP number? (If applicable)
What are you pronouns (optional)
How do you identify (check all that apply)? *
This event will be in American Sign Language. Do you have other access needs? (i.e. voice interpretation, CART)
Would you like us to contact your parents/family with program information?
Clear selection
Parent/family language and contact information (if applicable):
Is there anything else you'd like to tell us?
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