Online Registration

First Name *

Last Name *

Title/Position

Address *

City *

State *

Zip Code *

Home Contact Number

Home Email Address *

Work Contact Number

Work Email Address

School Business Name

District or County

Membership Status

Please select. You must be a current CAL-ED member as of March 12, 2010 to qualify for the discounted membership conference rate.

Please select: *

Member

Not a Member

If member:

Professional (open to all credentialed staff)

Associate (retired professionals, interpreters, aides)

College Student

Parent

Special Interest Groups

Groups meet on Friday afternoon

Parent

Administrator

Special Needs

Infant/Preschool

Itinerant Teacher

Communication Needs

All proceedings will be in American Sign Language and spoken English. Please indicate if you have other needs so we may accommodate you. Requests must be made by February 12th, 2010.

Please select:

Oral-English interpreter

Oral-Spanish interpreter

Deaf-Blind interpreter

Assistive Listening Device

Children Registration (skip this step if you register for yourself)

The Children’s Program accepts children from 3 to 15 years of age. All children must be out of diapers. Ages 16-18 are welcome to volunteer in the Children’s Program; however they will not be supervsed. An infant room will be provided for parents’ use, but no supervision will be provided.

Name of Parents/ Guardians

Emergency Contact during the conference

Cell/Pager #

Child #1

First Name

Last Name

Birth Date

Age

Grade in School

Deaf, HH or Hearing?

Deaf

Hard of Hearing

Hearing

Child’s T-shirt Sizes

Youth – S

Youth – M

Youth – L

Youth – XL

Adult – S

Adult – M

Adult – L

Adult – XL

Medical Information/Allergies

Physician’s Name

Physician’s Phone Number

Is there a need for a 1:1 aide?

No

Yes

Other important information we should know

Child #2

First Name

Last Name

Birth Date

Age

Grade

Deaf, HH, or Hearing

Deaf

Hard of Hearing

Hearing

Child’s T-shirt Sizes

Youth – S

Youth – M

Youth – L

Youth – XL

Adult – S

Adult – M

Adult – L

Adult – XL

Medical Information/Allergies

Physician’s Name

Physician’s Phone Number

Is there a need for a 1:1 aide?

No

Yes

Other important information we should know

Child #3

First Name

Last Name

Birth Date

Age

Deaf, HH or Hearing

Deaf,

Hard of Hearing

Hearing

Child’s T-shirt Sizes

Youth – S

Youth – M

Youth – L

Youth – XL

Adult – S

Adult – M

Adult – L

Adult – XL

Medical Information/Allergies

Physician’s Name

Physician’s Phone Number

Is there a need for a 1:1 aide?

No

Yes

Other important information we should know

Child #4

First Name

Last Name

Birth Date

Age

Grade in School

Deaf, HH, or Hearing

Deaf

Hard of Hearing

Hearing

Child’s T-shirt Sizes

Youth – S

Youth – M

Youth – L

Youth – XL

Adult – S

Adult – M

Adult – L

Adult – XL

Medical Information/Allergies

Physician’s Phone Number

Is there a need for a 1:1 aide?

No

Yes

Other important information we should know

After submitting, you will be directed to complete the last step of purchasing the registration fees.

California Educators of the Deaf and Hard of Hearing

Gallery

Subscribe to Our News!

Links

Archives