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SNRP Celebrate Nebraska Day Camp Registration Form
Registration Deadline: May 15, 2018
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* Indicates required question
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Gender
*
Male
Female
Age
*
Your answer
Grade
*
(Current 2017-2018 School Year)
K
1
2
3
4
5
6
Preferred Method of Communication
*
Oral
Sign Language
Total Communication
Other:
Food Allergies or Restrictions
*
Your answer
Accommodations Needed
*
Your answer
In order to make this the best possible experience for your child, is there anything specific staff should know about your child?
Your answer
School District
*
Your answer
Deaf Educator's Name
*
Your answer
Do you need to update your child's 2017-2018 Nebraska Regional Program health/permission forms?
*
(i.e. phone numbers, addresses, emergency contact, medicine, etc.)
No
Yes
I have not completed the forms for this school year
Please list the adult who will be responsible for picking up your child each day from camp and his/her contact phone number
*
Your answer
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