Silent Hope's Camp We Sign 2021 Registration
Campers: Deaf / Hard-of-Hearing / CODA (Hearing Children of Deaf Adult) / SODA (siblings)
FAITH ASSEMBLY OF GOD - 9307 CURRY FORD RD ORLANDO FL 32825
Dates: JULY 12 - JULY 16
Times: 7:30AM-6PM
Age: *
Gender: *
Camper's Name: *
Date of Birth: *
Name of Current School: *
CAMPER’s INFORMATION
Current Grade: *
School Address: *
CHILD LIVES WITH: *
Required
Mother or Guardian’s Name: *
CHILD IS *
Address: *
City, State, Zip: *
Email address *
Emergency Contact *
Please list at least 3 Emergency Contacts and their Phone Number
Authorization for Emergency Medical Care *
In the event that the emergency contacts cannot be reached in an emergency, I hereby give permission for the camp medical director to secure and administer necessary treatment, including hospitalization, for me. The medical director may release any records necessary for insurance purposes. Please enter your full name (parent/guardian) as your authorization
Insurance Information *
Is the child covered by medical/hospital insurance?
Insurance Information *
Carrier or Plan name / group # / member # / Name of insured / D.O.B of insured / relationship to applicant. Proof of insurance is REQUIRED. Submit a copy with application
Prescription Medication - For the safety and protection of all campers and staff, the medical director is required to hold all prescription medications in locked storage during the camp program. *
Do you have any prescribed medication you will need to take during camp?
Prescription Medication *
List prescribed and over the counter medication needed during camp
PARENT(S) / GUARDIAN INFORMATION
Mother or Guardian's Name: *
Address: *
City, State, Zip: *
County: *
Phone: *
Email: *
Father or Guardian’s Name: *
Address: *
City, State, Zip: *
County: *
Phone: *
E-mail: *
Has your child ever attended camp before? *
If the answer is yes, please let us know the camp's name
Indicate your child’s swimming experience: *
Required
Campers will receive a complimentary camp shirt. Please tell us your child’s T-shirt size *
Adults size : S, M, L, XL, XXL - Child size: M [10-12] L [14-16] XL [18-20]
How did you hear about Camp We Sign? [check one] *
Required
For Deaf / Hard-of-Hearing applicants, describe the severity of hearing loss *
Check any of the assistive devices your child uses *
Required
Indicate your child’s communication mode(s): [check all that apply]: *
Required
Please list any medical condition your child has as well as any diagnosis other than hearing loss *
Will your child need transportation assistance? How far will the parents be able to drive to bus pick up (if qualify for assistance) *
Please describe child (habits, behaviors, family interaction, social preferences (group activities, tends to be alone) *
Please provide any important information that will assist the staff in providing the child a memorable experience at Camp We Sign *
What is the child's favorite color, toys, hobbies, activities, etc *
Any area of concern the camp may be able to provide information and/or referral? *
Submit
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