Staying on Campus Registration

REGISTER EARLY – SPACE IS LIMITED FIRST COME, FIRST SERVED! • The following is required in order to confirm your registration:  One registration form per person, or one per family.  One release form per person, or one per family.  One Parent/Guardian release form required only for families approving their minor child to attend the program with a designated guardian. • Please complete all sections on forms. • Additional forms are available on our website: http://www.nmsd.k12.nm.us/outre ach/classesworkshops.php • Return via fax or regular mail to:  Fax 505-476-6371  Mail to address posted on registration form.

• Simple & comfortable lodging is provided in NMSD’s Cottages • Rooms have two twin beds, two closets & a private bath • Extra mattresses can be added to rooms for larger families • Simple bedding & towels are provided • Each cottage has a community kitchen with refrigerator • Rooms cannot be locked. Please bring something to secure your valuables or lock them in your car if you are concerned. • Cottages are air conditioned, but temperatures are not controllable. Bedrooms tend to run hot – some people bring fans

Questions? Contact our office at: 505-476-6400 Or email: [email protected] RID CEUs will be available for the event

See brochure for more information.

New Mexico School for the Deaf Center for Educational Consultation & Training (CECT)

2015 ASL Immersion TWO EVENTS THIS SUMMER!

Event 1: July 21-24 Event 2: July 28-31

Class Options CLASS LEVELS

Level 1: This is the first part of six-levels. No previous knowledge required. Level 2: Requires some prior sign instruction or interaction with people who are deaf. Level 3: Have basic conversational skills, seeking increased vocabulary and syntax. Level 4: Strong conversational skills, seeking increased vocabulary and fluency. Level 5: Seeking to build on existing communication fluency. Level 6: Tailored class for those who have mastered Level 5. Application of your skills, including comprehension practices. Must have completed Level 5 in a previous ASL Immersion (Staff will informally assess levels upon arrival and re-assign students if needed.)

Family Class: This class is designed for family members to learn signs along with their D/HH children under the age of 3. The program will be designed based on the skill level of the families who register. This class will only be offered if numbers allow.

For both weeks: RID CEUs offered for Upper Level ASL Class (level 4-6) participation. Up to 2.175 CEUs

The Event

ASL Immersion is a four-day intensive program in American Sign Language (ASL). The event includes periods of instruction in vocabulary and sentence structure, modeling and gestures. Students practice with each other, their teachers, and members of the ASL Immersion staff. Participants will leave with a more complete understanding of Deaf Culture and an improved ability to communicate in ASL.

Tentative Schedule

Children and Teen Programming

ASL Immersion Children and Teen program offers activities for children from 18 mo. to 17 yrs old who come from a family with a deaf or hard of hearing child. This program has deaf and hearing staff who will guide ASL learning through play. Deaf or hard of hearing children: under age 3 can attend the “Family Class” with their parents. This year, we are excited to introduce our new teen program* (12-17 year olds)! *The teen class is dependent on numbers.

Breakfasts and Lunches Provided

Breakfast 7:45a – 8:30a daily Lunch 11:45a – 12:45p daily (including Friday) Day 1 (July 20 OR July 27) 4p – 7p

Check in at NMSD

Day 2 (July 21 OR July 28) 8:55a – 9:10a 9:15a – 10:15a 10:15a – 11:45a 12:45p – 1:45p 1:45p – 4:00p 6:30p – 8:00p

Introductions Welcome Class Class ASL Activity/Class ASL Social

Day 3 (July 22 OR July 29) 8:30a – 10:00a 10:15a – 11:45a 12:45p – 1:45p 1:45p – 4:00p

Class Class Deaf Culture Skits ASL Activity/Class

Day 4 (July 23 OR July 30) 8:30a – 11:45a 12:45p – 1:45p 1:45p – 4:00p 5:30p – 7:30p Day 5 (July 24 OR July 31) 8:30a – 9:30a 9:30a – 10:00a 10:15a – 11:45a

Class Deaf Panel ASL Activity/Class BBQ and Social Class ASL Activity/Class Class

• A completed, signed release form is required with registration. • Bring your own diapers for your children who are not potty-trained. • Bring sunscreen! • Bring/dress your children in comfortable clothing (clothing you don’t mind getting wet and/or dirty). • If your child has any serious food allergies, please bring your own snacks. • Children in the children’s program will be participating in a variety of activities on and off campus. • If you have any concerns regarding your child participating, please let us know. • Please call if you have specific questions about activities in the children’s program!

2015 ASL Immersion Families of New Mexico with D/HH children attend for free Attendee/Family Contact _____________________________ Address ____________________________________ City_______________________ State_______ Zip____________ Phone Number ________________________________ Email Address_______________________________ Name of D/HH child in the family ______________________________ Are you a professional who works directly with a D/HH student? ___ Yes ___ No If yes, what is your position_________________________ District/School __________________

Program fees for paying participants New Mexico Resident

Tuition Only

$200.00/per person

X______ (# of participants)

Total

$ ________

New Mexico Resident

Tuition & Lodging

$250.00/per person

X______ (# of participants)

Total

$ ________

Out of State:

Tuition Only

$250.00/per person

X______ (# of participants)

Total

$ ________

Out of State:

Tuition & Lodging

$300.00/per person

X______ (# of participants)

Total

$ ________

Out of State families with D/HH children:

$75.00/per adult

X______ (# of participants)

Total

$ ________

$25.00/per child

X______ (# of participants)

Total $ ________ Grand Total $________

Attending week of (check one below): July 21-24____

July 28–31 ____

Refunds: Must be requested in writing (email or fax) seven days prior to first day of program.

See brochure for details regarding Levels and Family Class.

PAYMENT INFORMATION Enclosed: Check # ________ M.O./Cashier Ck#______________________ Purchase Order #_________________ PO in process: Name/Contact for PO:______________________ Phone #:__________________

Regular Classes Attendees (13 and older)

1) Select ONLY one level per attendee, 2) Staff will re-assigned students if needed. Level 1

Level 2

Level 3

Level 4

Lodging?

Level 5

Level 6

Family Classes Adults (18 and over)

Children AND Teen Program Attendees Children: 18 mo. – 11 yrs Teen: 12-17 yrs

Family Level 1

(check one below)

(check one below)

Auditory

Deaf

HH

Signing Cottage

Lodging?

Children (under 3yr)

Age

Talking Cottage

Hearing

Family Level 2

Language

Spoken

Sign

Both

Talking Cottage

Signing Cottage

Lodging? Talking Cottage

Roommate Preference

(all attempts will be made)

Signing Cottage

Vegetarian? Yes

Room Assignment with family

Room Assignment with family

MAIL TO: New Mexico School for the Deaf  Attn: CECT/ASL Immersion  1060 Cerrillos Rd  Santa Fe, NM 87505

No

Vegetarian? Yes

No

Additional Important Information Include special communication needs if applies (i.e. Deaf/Hard-of hearing, Deaf-blind, etc)

Additional Important Information Include special communication needs if applies (i.e. Deaf/Hard-of hearing, Deaf-blind, etc)

Vegetarian? Yes

No

Fax: 505-476-6371

Additional Important Information

For questions: 505-476-6400

Release Form Adult Attendee:_______________________________________  Parent (for families – this is the designated “family” contact)

 Guardian (to children listed below)

Cell Phone:___________________________

Adult Attendee:____________________ Adult Attendee:____________________ Adult Attendee:___________________ Adult Attendee:___________________ Teens Attending Adult Class: Name:____________________Age:_____

Name:____________________Age:_____

Name:____________________Age:_____

Teen/Child Program – 18 mo. to 17years (list below) NOTE: Related child care service for this program is free and only available for families with D/HH children. Teen/Child 1 First a n d Last Name C o mm u nic a ti o n Sign, Voice, Both, Other (select one – print at right) Age Deaf / Hard of Hearing/ Deaf-blind /Hearing (select one – print at right) Medical Information (list allergies or n/a if none) Medication and Dosage (list meds or n/a if none) Special Needs (specify or n/a if none) Other Important Information

Page 1

of 2

Teen/Child 2

Teen/Child 3

Teen/Child 4

RELEASE FORM PERTAINS TO ALL PROGRAM PARTICIPANTS Medical Release • • •

I understand that I am responsible for the medical needs for myself, children and family members listed on page one (including medication and/or medical equipment needed during our stay). I understand that in the event of a minor emergency, my child will receive simple first aid treatment and that I will be informed at the end of the program day. I will be responsible thereafter for the care of my child. In the case of a more serious injury or illness, appropriate outside emergency personnel will be called in, and I will be immediately informed of the emergency. The emergency personnel will decide the best course of action. I understand that I am responsible for administering all medications or any other medical treatment.

_______________________________________________ Signature

_________________ Date

Release of all Claims I hereby release the Teen/Child Care program, its agents and employees, from all actions, damages, causes of action, claims, or demands which I, my child/children, family members, my spouse, heirs, executors, administrators, or assigns, may have against the Teen/Child Care program, its agents and employees, for all personal injuries known or unknown which my child/children, has or may incur by participating in the Teen/Child Care program. I, the undersigned, have read this release and understand all its terms. I execute it voluntarily and with full knowledge of its significance.

_______________________________________________ Signature

_________________ Date

Photograph/Video Release I understand that photographs and/or videotapes may be taken during the course of the program. These images will be used for training, publicity and/or fund-raising purposes for the conference only. My signature below indicates consent for myself, my child/children and family members to be photographed and/or videotaped.

________________________________________________ Signature

_________________ Date

Field Trip/Transportation Release In the event that a field trip is scheduled, I give permission for my child(ren) to participate in off-campus field trips with the ASL Immersion Week – Teen/Children’s Program. All field trips will be within walking distance of NMSD and parents will receive communication regarding places and times of field trips on registration day. Note: Field trip update will be provided during registration. I also give permission to the Teen/Children’s Program to transport my child, individually or in a group, to and from all off campus activities.

________________________________________________ Signature Page 2

of 2

_________________ Date