Learning Experience and Adventure Program (2023)

LEAP for MIDDLE SCHOOL REGISTRATION 2025

Learning Experience and Adventure Program
Have you ever wanted to get to know others your age who also are deaf or hard of hearing? The Learning Experience and Adventure Program (LEAP) offers this opportunity virtually for middle schoolers to connect with other students who are deaf or hard of hearing!

Activities and games are run by adults who are deaf or hard of hearing and use LSL to communicate.

We look forward to welcoming you to the program!

Upcoming Session Dates:

-Saturday, January 25, 2025 | 12:30-3:00 pm EST

Eligibilty Requirements:

LEAP welcomes registrants who are in Middle School; 6th to 8th grade (11-13 years old). To qualify, registrants must have a bilateral or unilateral hearing loss. Registrants must also use Listening and Spoken Language as the primary method of communication. Remote Live and Automated Captioning are used during the LEAP program. The program is provided in English. If you have limited English proficiency, please make the LEAP staff aware and specify.

LEAP Registration Window:

Registration will be accepted on an ongoing basis. At least one week prior to the accepted session, registrants will be notified and provided additional details.

Registration Submission Verification (Important):

You must fill your email into the email validator field of the application. After you've submitted your registration, you will receive a confirmation email from Jotform. If you do not receive this confirmation, it means your registration is not complete. You can contact AG Bell at LEAP@agbell.org, if you do not receive a confirmation email from jotform.

If you have any questions or need further assistance, please email us at LEAP@agbell.org.
Please select which session(s) are preferred:*

Saturday, January 25; 12:30-3pm ET
Please select which LEAP Session(s) are preferred:

Session 1: Friday and Saturday, April 16-17Session 2: Friday and Saturday, May 14-15Session 3: Friday and Saturday, July 16-17No Preference

Contact Information

All Information is required.
Applicant / Child's Name*

First NameLast Name
Gender*

MaleFemaleOther
Preferred Pronouns
Ethnicity*
Race*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther
Date of Birth*

MonthDayYear
Year in School*
This should be the grade you are currently in during the 2024-2025 academic year.
Year in School (other)
Applicant / Child's E-mail*

Confirmation EmailPlease provide a personal email address, NOT a school email address, as the emails do not always go through due to being blocked or are considered spam.
Applicant / Child's Cell Phone Number*

Area CodePhone Number

Parent / Guardian Information
Parent / Guardian Name*

First NameLast Name
Relationship to Child:*

FatherMotherLegal Guardian
Parent / Guardian Cell Phone Number*

Area CodePhone Number
Home Phone Number*

Area CodePhone Number
We will communicate with you using E-mail – a valid e-mail address is required for sharing time-sensitive information and helping you prepare for the program. Please be sure to add LEAP@agbell.org to your e-mail address book. You will ONLY receive emails pertinent to LEAP.
Parent / Guardian E-mail*

Confirmation Email
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How did you hear about LEAP?*
Has your teen attended or applied to LOFT (Leadership Opportunity For Teens)?*

COPPA Compliance Provisions
1. Alexander Graham Bell Association's Representations and Warranties Regarding COPPA Compliance.  Alexander Graham Bell Association represents and warrants that, in the event that the Children’s Online Privacy Protection Act (“COPPA”) applies to any websites or online services provided by Alexander Graham Bell Association, Alexander Graham Bell Association represents and warrants to Blue Sky eLearn that Alexander Graham Bell Association shall comply with all applicable requirements of COPPA, as amended from time to time, including without limitation:

a. Post a clear and comprehensive online privacy policy describing Alexander Graham Bell Association's information practices for personal information collected online from children;

b. Provide direct notice to parents and obtain verifiable parental consent before collecting personal information online from children;

c. Give parents the choice of consenting to Alexander Graham Bell Association's collection and internal use of a child’s information, but in no event shall Alexander Graham Bell Association disclose that information to third parties (unless disclosure is integral to the site or service provided by Alexander Graham Bell Association, in which case, this shall be made clear to parents). 

d. Provide parents access to their child's personal information to review and/or have the information deleted;

e. Give parents the opportunity to prevent further use or online collection of a child's personal information;

f. Maintain the confidentiality, security, and integrity of information Alexander Graham Bell Association collects from children, including by taking reasonable steps to release such information only to parties capable of maintaining its confidentiality and security; and

g. Retain personal information collected online from a child for only as long as is necessary to fulfill the purpose for which it was collected and delete the information using reasonable measures to protect against its unauthorized access or use.

2. Alexander Graham Bell Association's Indemnification Obligations Regarding COPPA Compliance.  Notwithstanding anything to the contrary in this Agreement, Alexander Graham Bell Association shall indemnify, hold harmless, and defend Blue Sky eLearn and its officers, directors, employees, agents, affiliates, successors and permitted assigns against any and all losses, damages, liabilities, deficiencies, penalties, fines, costs, and/or expenses of whatever kind, including without limitation reasonable attorneys’ fees, arising out of or resulting from any breach or non-fulfillment of any representation or warranty with respect to COPPA under this Agreement or any other violations of COPPA by Alexander Graham Bell Association or its officers, directors, employees, agents, or affiliates.
Photo and Video Release
I hereby grant permission to the Alexander Graham Bell Association for the Deaf and Hard of Hearing (AG Bell) to use the photograph(s) and video(s) of {applicant} for unlimited use in any AG Bell publications, periodicals, brochures, displays, booklets, website and in any of AG Bell’s public relations or fundraising activities. I give and grant to AG Bell and its designees, licensees, successors and assigns, the right to use, publish and copyright, my child’s name, voice, likeness, actions and biographical data, in whole or in part. I hereby waive any right that my child or I may have to inspect or approve the media, any materials that may be used in connection with the media, or the use to which it may be applied.*
Contact Information Release
I hereby grant permission for my child’s email and cell phone number to be shared in a group list with others who participated in LEAP. Sharing of this information will be used to facilitate communication among LEAP attendees after participation in the program.*
AGREEMENT: This is to certify that I am the parent/legal guardian of the aforementioned LEAP Registrant. I support my child’s registration for the AG Bell LEAP program planned for 2025-2026. By signing my name below, I indicate that I have read, understand and accept the Terms and Conditions provided and the Agreement as stated above and affirm that all the information provided in this registration is correct and complete to the best of my knowledge.
Please do not submit your registration until you have read and responded to the two below questions:
Has your Parent or Teacher completed the short essay?

YesNo
Have you completed your 1-2 minute video of yourself? (Optional)

YesNo
Proceed to signature and submit.
Signature of Agreement*

Clear
Refer a Friend Incentive Program- Name of the Friend that referred you:
Should be Empty:

	Left Ear	Right Ear
Hearing Aid(s):
BAHA (s):
Cochlear Implant (s):

LEAP for MIDDLE SCHOOL REGISTRATION 2025

Contact Information

Parent / Guardian Information

Tell Us About Your Child's Hearing Loss

Communication

Tell us About You!

COPPA Compliance Provisions

Photo and Video Release

Contact Information Release