TSHA’s Summer Camp Enrollment

TSHA's Summer Camp

• Today's date
• Child's Name*
• Child's Date of Birth*
• M / F*
  • M
  • F
• 2nd Child's Name
• Second Child's Date of Birth
  MM slash DD slash YYYY
• M / F
  • M
  • F
• 3rd Child's Name
• Third Child's Date of Birth
  MM slash DD slash YYYY
• M / F
  • M
  • F
• Parent/ Guardian's Name*
  First Last
• Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
• Day/Cell Phone*
• Other Phone
• Email
• Describe camper's hearing or speech loss, and the preferred method of communication.*
• Explain any allergies or special needs.
• Anything else you'd like for us to know?
• In case of emergency, contact (other than parent/guardian listed above)*
  First Last
• Phone*
• Relationship to child*
• Second emergency contact (if you have one).
  First Last
• Phone
• Relationship to child
• Do you need a scholarship for your child? Yes/No
• One week of camp*
  $75 per deaf/hard of hearing camper $85 per hearing camper (siblings + CODAs) $35 CIT (Counselor in training. Ages 14+)
  
  
  This pricing includes entire weeks activities July 17-21 from 9am to 3pm. Campers are required to bring their own lunch.
  
  *Children who are deaf, hard of hearing and/or have communication disorders will get priority. Campers are required to bring their own lunch.
  
  Enrollment Deadline: July 5, 2023
  
  1 Hearing Camper1 Deaf/HH Camper2 Hearing Campers2 Deaf/hh Campers1 Deaf/1 Hearing1 Deaf/2 Hearing1 Deaf/3 Hearing2 Deaf/ 1 Hearing1 CIT (Counselor in training)
• Before and after care
  • Before care: 7:30am-9am
  • After care: 3pm-6pm
• Credit Card
  Card Details

  Cardholder Name
• Total
  $0.00
• Captcha

Δ