CampSIGN is a communication barrier free environment for boys and girls ages 8 to 17 who are deaf or hard of hearing. The primary goal for CampSIGN is for students who are deaf or hard of hearing from around the state regardless of their communication mode, to participate in the program. The philosophy of the camp is to provide an environment of acceptance and encouragement. This program is operatedby theOffice for Deaf and Hard of Hearing Services (DHHS) under DARS-DRS.

A special Counselor-in-Training (CIT) program is for developing leadership skills and preparing boys and girls ages 16 and 17 to become future camp counselors and leaders. CIT participants are former campers who meet the CIT program criteria as established by the CampSIGN committee. To obtain a CampSIGN or CIT application, please contact Ann Horn as per information below.

The camp staff is chosen to accommodate the variety of communication needs of the campers. Most of the counselors are professionals who work with individuals who are deaf or hard of hearing. Many of the counselors are deaf or hard of hearingthemselves and serve as excellent role models for the campers. Many counselors are former campers and CITs and return year after year to work with the program.

CampSIGN continues to use a beautiful campsite in the woodlands nearConroe, Texas just 35 miles north of Houston. Camp Misty Meadows is owned and operated by the Girl Scouts of San Jacinto. The dates for camp this year is July 22-July 28.

CampSIGN depends on donations to support the program though such donations do not cover the entire cost of the camp. Parents or guardians are asked to fill out an income information section located on the application form which is used to determine a camp feeeach child. There are two separate fees: application fee and camp fee. The total cost per camper ranges from $35.00 to $185.00 (including both application and camp fees) and depends on the income of the parent(s) or guardian(s). Medical exams and transportation are not included in these fees.

Tax deductible gifts and grants may be sent to Camp SIGN, c/o Office for Deaf and Hard of Hearing Services, P.O. Box 12306; Austin, Texas 78711. For more information, please contact Ann Horn at (512) 407-3250 by leaving a message or byTTY at 512-407-3251, or by e-mail:.

If your child is considered for CampSIGN, a pre-acceptance letter will be sent by May 16th, stating the cost for your child to attend. At that time, you will also receive the required medical instructions and release forms. Please note that a doctor must examine your child and sign the medical form.No child will be admitted without submitting all required and signed forms.

To register your child:

1. Return the completed camper application along with a check or money order of $35.00 to cover application fee required for each child on or before the deadline date, April 28th. This will reserve a space for your child. These should be mailed to CampSIGN, Office for Deaf and Hard of Hearing Services; P.O. Box 12306; Austin, Texas78711.

2.You should receive a pre-acceptance letter by May 16th, after which it is essential to complete the additional paperwork and submit any required payment by a deadline established in the letter. If you do not respond, the space will become available for the next camper on the list.

3.The cost of the medical examination and transportation of your child to and from CampSIGN are the RESPONSIBILITY of the parent/guardian.

NOTE:We cannot accept any applications after the April 28th deadline. We encourage you to send your child’s application and fees as soon as possible. All slots are filled first-come first-served.

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CAMPER INFORMATION(please print clearly)

Last Name / First Name / Birth Date / Age at camp date / Gender
Male
Female
Applicant’s Social Security Number / Camper’s Email address / School/City / Grade
T-Shirt-ADULT SIZE / Ethics / Status of Hearing Loss / Method of Communication
S
M
L
XL
XXL / Caucasian (White)
African- American
Hispanic/Latino
Asian Pacific
Native American
Other (specify): / Deaf
Hard of Hearing
Hearing Impaired
Cochlear Implant / American Sign Language
Signed Exact English
Sign Language
Oral
Other(specify):
PARENT/GUARDIAN INFORMATION:
Please check one of these boxes: PARENT GRANDPARENT GUARDIAN OTHER(Specify):
Last Name / First Name / Address and City, State, Zip
Home Phone number
(including area code) / Work Phone number
(including area code) / Cell Phone
(including area code) / Pager
Email Address: / For emergency, Contact Person (name) & Phone Number, Relationship?
MEDICAL INFORMATION
Had Diseases before: / Chronic or Recurring Illness / Allergies / Other Problems:
None
Chicken Pox
Measles
German Measles
Mumps
Other ( Specify): / None
Ear Infection
Seizures
Bleeding Disorders
Asthma
Other (Specify): / None
Hay Fever
Pollen
Plants
Animals
Insect stings
Medicine/drugs
Other (Specify): / None
Bed wetting
Sleeping Disturbances
Constipation
Nosebleeds
Fainting
Emotional Disturbances
Other (Specify):
Camper takes Medicine? / If take medicines, please list below. / Camper have behavior problems / Please check one or more below:
Yes
No / / Yes
No / Temper Tantrums
Hitting Others
Disobey
Uncooperativeness
Attention Span
Other (specify):

NOTE: ANY CAMPER THAT BECOMES A CONTINUAL PROBLEM AT THE CAMPSITE WILL BE SENT HOME IMMEDIATELY.

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INCOME REPORTING FORM

List the following for all members in the household (including children). List the average income per month for each member in the household. Income should be GROSS showing BEFORE taxes, insurances, deductible, etc. You may choose not to provide the income information. If so, the camp fee for your child is $150, plus $35 application fee.

Please check here if you do not wish to list the income information; however, you will be responsible for paying the full camp fee for this camper. Please initialize here:______

First Name / Last Name / Social Security Number* / Monthly Income
1.
2.
3.
4.
5.
6.
7.
8.

*If any of above receives FOOD STAMPS or “Aid to Families with Dependent Children” list their case number along with the SSI number.

I affirm that I am providing true and correct information regarding my child/foster child.

I hereby make application to CAMPSIGN for my child/foster child. I am submitting a non-refundable application fee of $35.00. I UNDERSTAND THAT I WILL BE CHARGED AND HELD RESPNSIBLE FOR ANY FEES INCURRED BY CHECKS SUBMITTED WITH INSUFFICIENT FUNDS.

I HEREBY AGREE TO RELEASE AND HOLD HARMLESS DHHS CAMPSIGN FROM ANY DAMAGES ARISING OUT OF PERSONAL INJURY OR SICKNESS DUE TO ANY ACCIDENT OCCURRING ON OR OFF THE CAMPPREMISES.

I GRANT PERMISSION TO DHHS CAMP SIGN OFFICIALS TO PROVIDE ANY AND ALL MEDICAL ATTENTION TO MY CHILD IN THE EVENT OF INJURY OR SICKNESS.

I GIVE PERMISSION FOR DHHS CAMPSIGN TO PHOTOGRAPH, USE AND RELEASE PHOTOGRAPHS OF MY CHILD FOR PURPOSE OF PUBLICIZING AND PROMOTING CAMPSIGN.

I UNDERSTAND THAT COMPLETE COPPERATION IS EXPECTED FROM MY CHILD/FOSTER CHILD.

I UNDERSTAND THAT I AM REPSONSIBLE FOR TRANSPORTATION TO AND FROM THE CAMP FOR MY CHILD/FOSTERCHILD.

SIGNATURE OF PARENT/GUARDIANDATE

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