Child's Name
*
First Name
Last Name
Describe your child's sign name.
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Birth Date
*
MM
DD
YYYY
Age at start of session
*
8
9
10
11
12
13
14
15
16
17
18
Camp Session
*
Gender
*
Preferred Pronouns
*
Preferred Cabin Assignment
*
Identity
*
Will your child have a sibling(s) or relative(s) attending this summer camp program?
*
Does your child qualify for the federal free lunch program, or receive SNAP or TANF benefits?
*
Does your child have any food allergies?
*
Check all that apply:
T-Shirt (Youth Size)
*
X-Small
Small
Medium
Large
X-Large
XX-Large
Adult Large
Adult X-Large
How did you learn about Camp Taloali?
*
Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Videophone / Phone Number
*
(###)
###
####
Text Number
*
(###)
###
####
Email
*
Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Text Number
*
(###)
###
####
Email
*
Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Text Number
*
(###)
###
####
Email
*
Choose a Payment method
Cash
Check
Credit/Debit
PayPal
Do you want to sign up for a Monthly Payment Plan?
Do you want information on camperships and community sponsorships?
Has the applicant ever attended camp before?
*
Please describe the applicant's swimming ability.
*
Describe the applicant's school/educational program (Deaf school Mainstream school with classroom for Deaf/HOH/DB children, Mainstream school and fully integrated? Other - please describe)
*
Is a 1:4 camper/staff ratio ok or will your child require more supervision? Does your child have a Behavior Support Plan and/or a one-to-one aide at school? Describe any additional assistance required.
*
What are some of the applicant's interests and hobbies?
*
Does the applicant uses hearing aid(s), cochlear implants, or a BAHA device?
*
If yes, what restrictions does your child have in camp activities?
Special instruction for the use of hearing aid(s), cochlear implants or BAHA devices.
Does your child communicate in sign language? Note: Sign Language is the main mode of communication at camp.
*
Indicate the applicant's communication mode(s): Check all that apply.
Please indicate any area of concern with communication so the camp can accommodate the applicant/camper's needs.
*
I give my permission for my child's school to share information on character/behavior reference with Camp Taloali.
*
Electronic Signature. You agrees that the electronic signatures, whether digital or encrypted, of the parties included in this Agreement, if any, are intended to authenticate this writing and to have the same force and effect as manual signatures
*
Grade Level Entering this coming fall.
*
Name of School and Contact name.
*
School Phone Number
*
(###)
###
####
Child Name
*
First Name
Last Name
Electronic Signature. You agrees that the electronic signatures, whether digital or encrypted, of the parties included in this Agreement, if any, are intended to authenticate this writing and to have the same force and effect as manual signatures
*
Today's Date
*
MM
DD
YYYY
Refusal to treat for religious or other reasons, please request waiver form for specific action to be taken by the camp for emergencies.
*
Electronic Signature. You agrees that the electronic signatures, whether digital or encrypted, of the parties included in this Agreement, if any, are intended to authenticate this writing and to have the same force and effect as manual signatures
*
Today's Date
*
MM
DD
YYYY
Electronic Signature. You agrees that the electronic signatures, whether digital or encrypted, of the parties included in this Agreement, if any, are intended to authenticate this writing and to have the same force and effect as manual signatures
*
Today's Date
*
MM
DD
YYYY
Electronic Signature. You agrees that the electronic signatures, whether digital or encrypted, of the parties included in this Agreement, if any, are intended to authenticate this writing and to have the same force and effect as manual signatures
*
Today's Date
*
MM
DD
YYYY
