Camp GDB Application (Virtual Session)

Virtual Camp GDB 2021

Open to youth who are blind or visually impaired, ages 14-17, who are interested in the guide dog lifestyle and considering a guide dog for mobility.

Date(s): June 28- July 2, 2021
Location: Zoom
Room for 24 participants

Application Deadline: Friday, June 11, 2021

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* 1. First and Last Name

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* 2. Personal Pronouns

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* 3. Date of Birth

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* 4. Email Address

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* 5. Address

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* 6. City, State, Zip

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* 7. Home Phone Number

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* 8. Camper's Cell Phone Number

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* 9. Ethnicity (Optional)

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* 10. Primary Language Spoken

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* 11. Are you legally blind?

Yes

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* 12. Are you totally blind or partially sighted?

Partially sighted

Totally Blind

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* 13. If visually impaired, please describe your functional vision.

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* 14. What is the cause of your visual impairment?

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* 15. Aside from blindness, please list and describe any other physical and/or cognitive disabilities.

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* 16. Do you currently use a mobility aid?

Yes

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* 17. If yes, please indicate what kind of mobility aid you currently use.

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* 18. Tell us about your experience with dogs, if any?

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* 19. Have you attended Camp GDB before?

Yes

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* 20. If yes, when?

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* 21. Why do you want to attend Camp GDB?

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* 22. How do you prefer to receive printed materials?

Standard print

Large print

Braille

Audio

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* 23. Camper's t-shirt size

Small

Medium

Large