ASL Summer Camp 2026

Camp Registration Form

These forms are required for your children to attend camp.
Camper's Information
Camper Name*
Nickname
Date of Birth*

MonthDayYear
Age:
Current Grade*
School Camper Attends*
T-Shirt Size*
My child is:*
Preferred method of communication*
What are the TOP 3 reasons you would like your child to attend camp:*

To meet other deaf/hard of hearing childrenLearn ASLLiteracySTEMHave fun!Social SkillsCommunicationArts/CraftsOther
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.
THIS CAMP IS ONLY FOR DEAF/HARD OF HEARING, CODA'S, AND SIBLINGS OF DEAF/HARD OF HEARING.

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Home Phone
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Parent's Work/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would you like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone
Parent information

Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Home Phone
Same address as first parent?

Yes
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Parent's Work/School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneWork PhoneHome Phone

Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. The first emergency contact must be over the age of 18.
Information

Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number
Relationship to Child*
Information

Emergency Contact #2
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Secondary Phone Number
Relationship to Child

Photography
I give permission for WVDSC to share photos of my child on their website, Facebook, brochures, flyers, or other social media.
Yes, you may use my child's photo.No, do not share photos of my child
Parent signature

Clear
Activity Consent
INFORMED CONSENT, RELEASE AGREEMENT, AND AUTHORIZATION: I herby give approval for my child's participation in all activities during WV Deaf Service Center's Summer Camp. In exchange for acceptance as a camper with WVDSC, I assume all risks and hazards incedential to paricipation in activities and release, resolve, hold harmless WVDSC and all it's respective staff, officers, agents, representatives, and volunteers from any liability from any injuries to said child arising from traveling to, participation in, or returning from selected camp sessions.

In case of injury to said child, I herby waive all claims against the aforementioned parties including all staff, volunteers, affiliates, all participants, sponsoring agencies, advertisers, and if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all physical activity, including but not limited to: falls, breaks, scrapes, scratches, bruising, concussions, etc.
Parent signature

Clear
Please read throughly the following information. When you are done please sign below acknowledging that you have read this information, and that your child agrees to follow these policies/procedures for the duration of camp.
Signature

Clear
Should be Empty:

Camp Registration Form

Camper's Information

THIS CAMP IS ONLY FOR DEAF/HARD OF HEARING, CODA'S, AND SIBLINGS OF DEAF/HARD OF HEARING.

Parents' Information

Parent information

Emergency Contacts/Authorized Pickup

Information

Information

Medical / Health Information

Medication

Photography

Activity Consent