Deaf Blind Shabbaton

Registration Form 2019

This registration form is for Deafblind participants and non-SSP family members only. SSPs have a separate registration.

Deafblind Conference Registration Fee:
• Register by February 28 - $175 per person
• Register March 1 - March 31 - $200 per person

Registration fee is somewhat higher this year due to increased costs and decreased grant funding. The Shabbaton is still generously subsidized by the Macks Center for Jewish Education and other private donors.

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* 1. Contact information (all fields are required where applicable)

First and Last Name *

Nickname (if applicable)

Address *

Address 2

City/Town *

State/Province

ZIP/Postal Code *

Country *

Email Address *

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* 2. Primary Phone (required)

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* 3. What type of phone is your primary phone number? (required) Please check all that apply.

Voice

TTY

Text

V/TTY

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* 4. Alternate phone number

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* 5. What type of phone is your alternate phone number? Please check all that apply.

Voice

TTY

Text

V/TTY

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* 6. Gender (required)

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* 7. Age (required)

For the next few questions, please read all the options. We want to make sure you get the services that you need.

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* 8. Reading Preference: (required)

Regular print

Large print

Braille

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* 9. For those that require large print, please answer

What font do you prefer?

What size font for large print?

Will you bring your own prayer book?

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* 10. If you require Braille for reading, please indicate what type of Braille

Contracted Braille

Uncontracted Braille

Unified English Braille (UEB)

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* 11. What are your SSP needs? Please check all that apply (required).

At night

Around crowds

All the time

I don't need an SSP

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* 12. At what times do you need an interpreter? Please check all that apply. (required)

During meals

At meetings or activities

All the time

I don't need an interpreter

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* 13. What is the best way for people to communicate with you in person? Please check all that apply (required)

Visual ASL

Lip reading

Tactile ASL

Tracking Signed English

Tracking ASL

Visual Signed English

Tactile signed English

Listening or assistive listening devices, no signing

Fingerspelling

Print on palm

Other (please specify)

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* 14. What is the best way for you to communicate with people in person? (required). Please note: we do not provide Hebrew speaking or ISL interpreters. If you do not speak English or ASL please bring your own interpreter who can communicate in English or ASL.

Spoken English

ASL

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* 15. For your safety, please list and explain any medical condition that we need to know about, including medications currently taking (ex: diabetes or, epilepsy). (required)

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* 16. Please list any allergies you have

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* 17. Do you have any special diet, food restrictions or other special accommodations? (required)

Vegetarian

Vegan

No Red meat

Cholov Yisroel

None

Other (please be specific and include preferences or other requirements)

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* 18. Do you consider yourself Jewish? (required)

Yes

It’s complicated (please explain)

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* 19. Please explain your Jewish learning experience (required)

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* 20. Is your significant other/spouse or another relative or friend coming for the weekend? If your significant other will be joining us, you will automatically be assigned a private room with a private bathroom. (required)

Yes and will not be my SSP

Yes and will be my SSP

Yes and can be an SSP for anyone

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* 21. If you know whom you want to room with, please enter their name below

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* 22. What transportation will you take to Baltimore? We can provide transportation from BWI airport, train station and bus station to the Pearlstone Center. (required)

Someone will drive me to Pearlstone

I will fly into BWI airport

I will take a train to Baltimore Penn Station

I will take a bus into downtown Baltimore

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* 23. Which of the following applies to how you will travel? (required)

I will travel with an SSP

I will travel with an escort who will not be part of the Shabbaton

I will travel with a spouse who will not be my SSP for the weekend

I will travel independently and need someone to meet me

I need help arranging transportation

I need transportation from DeafBlind Camp of MD

Please contact me

Other (please specify)

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* 24. If you are traveling with someone, please provide their name

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* 25. Permission for Photography:
By typing my name here, I give permission for other participants to photograph and videotape me during the weekend, which may be used online and in promotional material. (No photos or video will be taken on Shabbat.) (required)

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* 1. Contact information (all fields are required where applicable)

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* 2. Primary Phone (required)

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* 3. What type of phone is your primary phone number? (required) Please check all that apply.

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* 4. Alternate phone number

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* 5. What type of phone is your alternate phone number? Please check all that apply.

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* 6. Gender (required)

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* 7. Age (required)

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* 8. Reading Preference: (required)

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* 9. For those that require large print, please answer

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* 10. If you require Braille for reading, please indicate what type of Braille

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* 11. What are your SSP needs? Please check all that apply (required).

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* 12. At what times do you need an interpreter? Please check all that apply. (required)

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* 13. What is the best way for people to communicate with you in person? Please check all that apply (required)

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* 14. What is the best way for you to communicate with people in person? (required). Please note: we do not provide Hebrew speaking or ISL interpreters. If you do not speak English or ASL please bring your own interpreter who can communicate in English or ASL.

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* 15. For your safety, please list and explain any medical condition that we need to know about, including medications currently taking (ex: diabetes or, epilepsy). (required)

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* 16. Please list any allergies you have

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* 17. Do you have any special diet, food restrictions or other special accommodations? (required)

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* 18. Do you consider yourself Jewish? (required)

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* 19. Please explain your Jewish learning experience (required)

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* 20. Is your significant other/spouse or another relative or friend coming for the weekend? If your significant other will be joining us, you will automatically be assigned a private room with a private bathroom. (required)

Question Title

* 21. If you know whom you want to room with, please enter their name below

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* 22. What transportation will you take to Baltimore? We can provide transportation from BWI airport, train station and bus station to the Pearlstone Center. (required)

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* 23. Which of the following applies to how you will travel? (required)

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* 24. If you are traveling with someone, please provide their name

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* 25. Permission for Photography:By typing my name here, I give permission for other participants to photograph and videotape me during the weekend, which may be used online and in promotional material. (No photos or video will be taken on Shabbat.) (required)

* 25. Permission for Photography:
By typing my name here, I give permission for other participants to photograph and videotape me during the weekend, which may be used online and in promotional material. (No photos or video will be taken on Shabbat.) (required)