Silent Hope's Camp We Sign 2018 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 9 - JULY 13
Times: 7:30AM-6PM
Age: *
Your answer
Gender: *
Camper's Name: *
Your answer
Date of Birth: *
Your answer
Name of Current School: *
Your answer
CAMPER’s INFORMATION
Current Grade: *
Your answer
School Address: *
Your answer
CHILD LIVES WITH: *
Required
Mother or Guardian’s Name: *
Your answer
CHILD IS *
Address: *
Your answer
City, State, Zip: *
Your answer
Email address *
Your answer
Emergency Contact *
Please list at least 3 Emergency Contacts and their Phone Number
Your answer
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
Your answer
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
Your answer
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
Your answer
PARENT(S) / GUARDIAN INFORMATION
Mother or Guardian's Name: *
Your answer
Address: *
Your answer
City, State, Zip: *
Your answer
County: *
Your answer
Phone: *
Your answer
Email: *
Your answer
Father or Guardian’s Name: *
Your answer
Address: *
Your answer
City, State, Zip: *
Your answer
County: *
Your answer
Phone: *
Your answer
E-mail: *
Your answer
Has your child ever attended camp before? *
If the answer is yes, please let us know the camp's name
Your answer
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 *
Your answer
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 *
Your answer
Will your child need transportation assistance? How far will the parents be able to drive to bus pick up (if qualify for assistance) *
Your answer
Please describe child (habits, behaviors, family interaction, social preferences (group activities, tends to be alone) *
Your answer
Please provide any important information that will assist the staff in providing the child a memorable experience at Camp We Sign *
Your answer
What is the child's favorite color, toys, hobbies, activities, etc *
Your answer
Any area of concern the camp may be able to provide information and/or referral? *
Your answer
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