Resources for Parents

Explore The Outdoors!

August 4 - 7, 2013

A special four-day program for teens with hearing loss entering grades 9-12!

Participants will explore nature through camping, hiking, swimming and zip-lining in beautiful Western Massachusetts. This program is designed for teenagers with hearing loss who communicate using listening and spoken language and provides an excellent opportunity for teens in the mainstream to connect. Exploring will be led by experienced Teachers of the Deaf and young adult role models.

Activities include:

Camping at DAR State Forest
Hiking
Zip-lining
Ropes course
Sharing stories around the campfire

Early registration rate is $350 per participant. After July 3, 2013, program cost is $395.

For more information, contact Martha deHahn, Director of Program Information, at mdehahn@clarkeschools.org or 413.587.7387. There is transportation from Bradley International Airport in Hartford, CT to the camp area, courtesy of Clarke Schools for Hearing and Speech.

Applicant Information

First Name*

Last Name*

Age

Date of Birth

Sex

Address*

City*

U.S. State

ZIP Code*

Country*

Parent Information

Parent(s)

Main Contact Email*

Parent 1 Name*

Parent 1 main phone number*

Parent 2 Name

Parent 2 main phone number

Educational & Summer Program Information

What school do you attend?

What grade are you in?

Type of school program

Other

Have you attended any Clarke Summer Program before?

How did you hear about this Clarke Summer Program?

Why are you interested in attending this program?

Tell us about other summer programs you may have attended in the past:

Residential

Day

With hearing-impaired children

With hearing children

For how many years?

Briefly describe

Do you have any outdoor overnight experience?

If yes, please explain

Hearing/Communication and Health Information

Please tell us about your hearing loss:

Profound (90 dB - 120 dB)

Severe (60 dB - 90 dB)

Moderate (30 dB - 60 dB)

Mild (10 dB - 30 dB)

Do you wear hearing aid(s)?

Do you have a cochlear implant?

How good are your auditory/oral communication skills? Select one answer in each section.

Listening?

Speech?

Other than a hearing loss, do you have any other special needs?

Do you have any health or medical problems that would limit your participation in the sports and recreation portion of the program?

If you answered yes to either of the above two (2) questions, please explain

Do you take medication?

If yes, please list

Payment Information

The total cost of the program is $395. The early registration rate of $350 is available through July 9, 2013.

A $100 deposit is required with this application. This deposit is applied to the tuition if the child is accepted. If a child is unable to attend our program, a full refund can be made if we are notified in writing of his/her withdrawal at least four weeks prior to the starting date.

You can make this $100 deposit by CHECK or by CREDIT CARD or PAYPAL.

If child is accepted, the balance is due by Wednesday, July 22, 2013.

Payment Method*

Comments or Questions?

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Clarke Schools for Hearing and Speech

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Resources for Parents

Explore The Outdoors!

August 4 - 7, 2013