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ILHV GBYS Event Registration Form
Your Name
*
First Name
Last Name
E-mail
*
example@example.com
Which event will you be attending?
*
Dream Big! Activity at Cook Memorial Public Library in Libertyville
Dream Big! Activity at Schaumburg Public Library
Which best describes you?
*
Please Select
Parent/guardian of a child who is deaf/hard of hearing
Professional working with DHH children
Other (please specify)
If "Other", please specify
What age is your child who is deaf/hard of hearing?
*
Please Select
Infant/Toddler (Birth up to 3rd birthday)
Preschool (3 years old up to 6th birthday)
Elementary (6-11 years old)
11 or older
I do not have a child who is deaf/hard of hearing
Are you currently matched with a Parent Guide through Guide By Your Side?
Yes
No, but I was previously enrolled in the program
No
Unsure
Not applicable
If you have worked with a Parent Guide, what is/was their name?:
Would you like more information about the Guide By Your Side program?
Yes
No
Do you require any communication accommodations? (Please note, we may be unable to accommodate requests made less than 2 weeks before the event.)
No, I do not require any communication accommodations.
Yes, I need ASL interpretation for an adult.
Yes, I need ASL interpretation for a child.
Yes, I need ASL interpretation for BOTH an adult and a child.
Submit
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