Blended Bridges Camp Participant Form

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Camp Schedule 2025

Tuesday, July 22:

5:30pm - Orientation / Meet & Greet
6:00pm - Dinner
7:00pm - Program & Family Activity
7:30pm - Dismissal

Thursday, July 24:

9am - Welcome & Dancercise
9:10am - Father Time (devotion)
9:30am - Music
10:00am - Outdoor Fun
10:40am - Centers
12:00pm - Lunch
12:30pm - Family Activity
1:00pm - Dismissal

Friday, July 25:

9am - Welcome & Dancercise
9:10am - Father Time (devotion)
9:30am - Music
10:00am - Outdoor Fun
10:40am - Centers
12:00pm - Lunch
12:30pm - Support Groups
2:00pm - Dismissal

Saturday, July 26:

9am - Welcome & Dancercise
9:10am - Father Time (devotion)
9:30am - Music
10:00am - Outdoor Fun
10:40am - Centers
12:00pm - Lunch
12:30pm - Chat with Max the Fox
1:00pm - Dismissal

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Your Full Name* This field is required.

First Name

Last Name

3

Email* This field is required.

example@example.com

4

Phone Number* This field is required.

Area Code

Phone Number

5

Mailing Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

7

How did you hear about Blended Bridges ASL Camp?* This field is required.

Google / Search Engine

Facebook

Friend / Family

Other

8

List each family member's first & last name (include ages for children).* This field is required.Please put each individual on a separate line. NOTE: We strongly encourage ALL parents, siblings and other household members to attend, if possible. **At least one parent/guardian must accompany your children.**

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T-shirt Sizes (pt 1)Additional family members can be entered on the next page.

Family Member 1 (name)

T-shirt Size

Family Member 2 (name)

Family Member 3 (name)

Family Member 4 (name)

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T-shirt Sizes (pt 2)If there are no additional family members, hit Next.

Family Member 5 (name)

T-shirt Size

Family Member 6 (name)

Family Member 7 (name)

Family Member 8 (name)

11

Does anyone in your family have a food allergy?If YES, please describe below in detail. If NO, please continue to the next question.

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How would you best describe your family's sign language level?* This field is required.Select the closest level to the majority of your family's skills.

Newbie (No signing experience)

Beginner (can fingerspell and use basic signs)

Intermediate (can have a simple conversation in ASL)

Advanced (fluent in ASL)

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What is your deaf child/children's name(s)?

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What is the level of your child's hearing loss?* This field is required.

Mild Hearing Loss

Moderate Hearing Loss

Moderately Severe Hearing Loss

Severe Hearing Loss

Profound Hearing Loss

Unsure

15

Does your child use amplification?

YESNO

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What is your child's primary method of communication?* This field is required.

Spoken English / Written English

American Sign Language

Signed English or anything in between ASL and Signed Exact English

Home Signs / Gestures

Unsure

Other

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If your deaf child has other special needs, describe those below.Please include any accommodations which would be helpful for us to provide for your child. (ex. picture schedule, one-on-one assistant, etc.)

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If your child is autistic, please select the degree of autism.Level 1 ASD: mild, some difficulty socializing, needs partial assistance with normal activities Level 2 ASD: moderate, more difficulty socializing, very narrow interests, some repetitive behaviors Level 3 ASD: severe, extreme difficulty socializing, responds only to direct approaches, constant repetitive behaviors

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What type of support services are you currently receiving for your child?(Ex. Beginnings, HI Teacher, etc)

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Are any of your hearing children autistic? If so, please select the degree of autism.Level 1 ASD: mild, some difficulty socializing, needs partial assistance with normal activities Level 2 ASD: moderate, more difficulty socializing, very narrow interests, some repetitive behaviors Level 3 ASD: severe, extreme difficulty socializing, responds only to direct approaches, constant repetitive behaviors

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Do any of your hearing children have other special needs? If so, please describe them below.Please include any accommodations which would be helpful for us to provide for your child. (ex. picture schedule, one-on-one assistant, etc.)

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Family Photo: Let's put a face with a name!Upload a family photo we can include with your registration records (optional)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Do we have permission to use photos/videos taken of your family while they are at Blended Bridges camp for social media and promotional purposes?

Yes

No

Other

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"I understand and agree that the listed parent(s) / guardian(s) are fully responsible for the children listed in this form. I hereby agree to hold harmless Blended Fellowship and all of its volunteers and staff."

Yes, I agree.

Other