Camp SIGN Application for Campers

Once you complete the application below, mail in your $35 application fee to:

Camp SIGN
Office of Deaf and Hard of Hearing Services
P.O. Box 12904
Austin, Texas 78711    

Be sure your camper's FULL NAME is clearly printed on the memo line of your check or money order.

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* 1. Camper Last Name:

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* 2. Camper First Name:

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* 3. Camper Birth Date (MM/DD/YY):

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* 4. Age at Camp Date:

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* 5. School:

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* 6. Grade in 2019-2020 School Year:

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* 7. Gender:

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* 8. Race/Ethnicity:

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* 9. T-Shirt Size (Adult Unisex)

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* 10. Status of Hearing Loss:

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* 11. Camper's Method of Communication

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* 12. Parent or Guardian Information

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* 13. Parent/Guardian Last Name:

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* 14. Parent/Guardian First Name

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* 15. Parent Contact Information:

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* 16. Person to Contact in Case of Emergency:

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* 17. Behavioral Information: To better care for your child, please provide any information about their behavior or physical, mental, emotional, and social health that you think is important, or that may affect the camper's experience at Camp SIGN (i.e. attention deficit, sleep disturbances, shyness, etc.) Use the space below or call (512) 982-1709 (V/VP). Note: Any camper who becomes a continual problem at the camp site will be sent home.

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* 18. Income Reporting: List the average monthly income for each member in the household including children.  Report gross income (amount before taxes, insurance, or deductions).  You may choose not to provide the income information.  If you do not provide income information, you must pay the full camp fee plus the application fee for your child.  The amount due will be listed in the pre-acceptance letter. *If any member of the household is in the Supplemental Nutrition Assistance Program (SNAP) or received Temporary Aid to Needy Families (TANF), list his or her case number as well as the Social Security Number.

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* 19. By initialing next to each line below, I affirm that:

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