ENVISION Blind Sports Camper Application
Application to reserve your spot at ENVISION Blind Sports 2018 Summer Camp!
June 10th-15th
Cost: $400
Name: *
Your answer
Age: *
Your answer
Date of Birth: *
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Sex: *
Height: *
Your answer
Weight: *
Your answer
Shoe Size: *
Your answer
T-Shirt Size: *
Level of Vision: *
Vision Condition: *
Your answer
Additional Visual Information: *
Check all that apply
Required
What size print do you need? *
Secondary impairments/disabilities: *
Your answer
Please describe any independent living or self-help skills where the child will require any additional assistance (beyond basic mobility and orientation skills): *
Your answer
School: *
Your answer
Who is your vision teacher? *
Your answer
Vision Teacher Email *
Your answer
Parent/Guardian: *
Your answer
Address: *
Please provide your full address
Your answer
Phone Number: *
Your answer
Email Address: *
Your answer
Do you require financial assistance to attend camp? *
How many years have you attended this camp? *
Your answer
Why do you want to attend the ENVISION Blind Sports Summer Camp? *
Your answer
Payment *
Camp Fee: $400 (Mail checks to ENVISION Blind Sports, 88 Seidle Rd., Mercer, PA 16137)
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