• 2026 Camp Registration Form

    2026 Camp Registration Form

    Please correctly fill the registration form below.
  • Child's Gender*
  • Child is...*
  • Please choose which ethnicity best describes the child.*
  • Relationship to the camper*
  • Format: (000) 000-0000.
  • T-Shirt Size for your child*
  • Do we have permission to baptize your child?*
  • Do we have permission to take pictures for our website and/or social media pages?*
  • [Alabama Resident Only] We will try do our best to provide transportation for anyone who has limited or no transportation. Times and Desitnation area will need to be arranged. Do you need transportation to and/or from camp?
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Camper's Health Form

    This information will only be viewed by the Deaf Camp directors and the Deafquake's Medical team. This information will NOT be shared by anyone outside of Deafquake.
  • Format: (000) 000-0000.
  • If your child had one or more of the following diseases, please check all that apply.*
  • Please check any allergies that the child has:*
  • Dietary restrictions/food allergy*
  • My child is subject to:*
  • About when was the date of last Tetanus shot?*
     - -

  • Mental, Emotional, and Social Health

    This information will only be viewed by the Deaf Camp directors and Deafquake's Medical team. This information will NOT be shared by anyone outside of Deafquake. (Note: Deafquake Camp admin team want to make sure that camp is a safe place for everyone. We want to be prepared to provide any support that may be needed.)
  • Have your child has ever been treated for attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (AD/HD)?*
  • Have your child has ever been treated for emotional or behavioral difficulties or an eating disorder*
  • During the past 12 months, have your child seen a professional to address mental/emotional health concerns?*
  • Had a significant life event that continues to affect your child's life? (History of abuse, death of a loved one, family change, adoption, foster care, new sibling, survived a disaster, others)*
  • Is your child prone to hurting themselves or others: intentional or unintentionally. We want to make sure we will provide an environment to keep all campers and staff safe.*
  • I give permission for my child to take the following over the counter medication as needed for any symptoms that may arise to be given by the Nurse, Director, or Medical Staff:*
  • Please chose one (regarding previous question):*
  • Does your child have medication(s)?*
  • How many medication do your child have?*
  • 1c. When it is given
  • 2c. When it is given
  • 3c. When it is given
  • 4c. When it is given
  • What kind of hearing device?*
  • I understand and agree that Deafquake is not responsible for damages/ loss of hearing devices.*
  • Date of birth of the person on the insurance card:*
     - -
  • Is this coverage for a dependent?*
  • Format: (000) 000-0000.
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  • WAIVER & RELEASE

    My child plans to attend the Deafquake in Pisgah, Alabama on the week of July 2-6, 2026. I fully understand that injury or illness could result from or during my child’s participation in this event. In case of an accident or illness, I give my permission for the camp to release medical information in order for my child to receive medical treatment as deemed appropriate, including x-rays and any medical tests or treatments as determined by the hospital. I will assume full responsibility for any medical bills, damage or death. Deafquake will not be held responsible for accidents, injuries, or loss of property. I also understand that after a visit to the hospital for injury or illness, the Deaf Camp Directors will determine if my child can return to camp or needs to go home. BY SIGNING THIS DOCUMENT, YOU ARE WAIVING CERTAIN LEGAL RIGHTS AND ASSUME FULL RESPONSIBILITY FOR YOUR CHILD AT THIS RETREAT FOR THESE DATES.

  • Registration & Payment
    The full cost of camp is $180 per child.

    Deafquake offers limited sponsorships, reducing the cost to $90 per child.

    Payment Options
    Pay by cash, check, or CashApp ($Deafquake). Please include the child’s name.

    • $90 sponsored rate
    • $180 full cost
    • $180 full cost – payment plan (4 payments of $45)
      • $45 is due when this registration is submitted and is non-refundable.
        All payments must be completed on or before the first day of camp.
    • Full sponsorship
      • Contact info@deafquake.org to request a full sponsorship. Please note: Sponsorships are limited and first-come, first-served.
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          Sponsored Rate Camper Registration
          $90.00
            
          Full Payment Camper Registration
          $180.00
            
          Full Cost with 4x Payment Plan ($45 x 4)

          $45 is due when this registration is submitted and is non-refundable. All payments must be completed on or before the first day of camp.

          $45.00
            
          Total
          $0.00
        		•

          Choose from one of the PayPal options to make your payment.

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