New Mexico School for the Deaf

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1 New Mexico School for the Deaf Center for Educational Consultation & Training (CECT) REGISTER EARLY SPACE IS LIMITED FIRST COME, FIRST SERVED! Now June 8 Early registration for New Mexico residents April 30 June 8 Early registration for out-of-state residents June 8-22! Final registration for all! The following is required in order to confirm your registration: Forms can be filled out individually or by a group. The Parent/Guardian Release Form is required 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: classesworkshops.php Return forms Fax Mail to address posted on registration form. scanned forms to: CECTevents@nmsd.k12.nm.us 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 better understanding of Deaf Culture and an improved ability to communicate in ASL. RID CEUs will be available for the event Offered for Upper Level ASL Class (level 4-6) for full participation 1060 Cerrillos Road, Santa Fe, NM CECT/Main: Fax:

2 C H I L D R E N A N D TEEN P R O G R A M S offer activities for children from 18 mo. to 17 years old who come from a family with a Deaf or hard of hearing child. These programs have Deaf and hearing staff who will guide ASL learning through play and meaningful activities. Deaf or hard of hearing children age 3 and under can attend the Family Class with their parents. The teen program is for year olds! A completed, signed release form is required with registration. Children and teens will be participating in a variety of activities on/off campus. If your child has any serious food allergies, please bring your own snacks (enough for 4 days). Please call if you have specific questions about activities in the children s program! TENTATIVE SCHEDULE Breakfasts and Lunches Provided Breakfast 7:45a 8:30a daily Lunch 11:45a 12:45p daily (including Friday) Check In (July 23 OR July 30) 4p 7p Check in at NMSD Day 1 (July 24 OR July 31) 8:55a 9:10a Introductions 9:15a 10:15a Welcome 10:15a 11:45a Class 12:45p 1:45p Class 1:45p 4:00p ASL Activity/Class 6:30p 8:00p ASL Social Day 2 (July 25 OR August 1) 8:30a 10:00a Class 10:15a 11:45a Class 12:45p 1:45p Deaf Culture Activity 1:45p 4:00p ASL Activity/Class Day 3 (July 26 OR August 2) 8:30a 11:45a Class 12:45p 1:45p Deaf Panel/Discussion 1:45p 4:00p ASL Activity/Class 5:30p 7:30p Dinner and Social Day 4 (July 27 OR August 3) 8:30a 9:30a Class 9:30a 10:00a ASL Activity/Class 10:15a 11:45a Class 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. 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. Some classes may be cancelled if registration numbers are too low. Staff will informally assess levels and re-assign students if needed. Staying on Campus Simple & comfortable lodging is provided in NMSD s Cottages Each cottage has a community kitchen with frig (label food) Rooms have two twin beds, two closets & a private bath Cottages are air conditioned, but temp is not controllable Extra mattresses can be added to rooms for larger families Bring extra blankets in case it gets cold Simple bedding & towels are provided Bedrooms may run hot some people bring fans Bring/dress your children in comfortable clothing (clothing that may get wet and or dirty). Rooms cannot be locked when you leave. Please bring something to secure your valuables or lock them in your car if you are c oncerned.!!! See registration form for registration dates, prices and deadlines!!!

3 R e g i s t r a t i o n F o r m Page one and page two are required to complete your registration. Attendee (for families this is also the main contact) Address City State Zip Phone Number _ Address Name of D/HH child in the family Last name: First Name: Age: Are you a professional who works directly with a D/HH student? Yes No If yes, what is your position District School Families of New Mexico with D/HH children attend for free if registered before 6/8/18 New Mexico Residents R a t e s f o r : N o w J u n e 8 J u n e 8 J u n e 2 2 F a m i l i e s w i t h D / H H C h i l d r e n K12 Provisionally Licensed Interpreters Working in NM Schools *provide a copy of your license with your registration form. No charge No charge $75/Adult, $25/ Child $75/Adult Individual Tuition $200/per person $250/per person Indv/Tuition/Lodging $250/per person $300/per person Breakfast & Lunches provided for all participants! Out-of-State Residents (registration opens on April 30th) R a t e s f o r : A p r i l 3 0 J u n e 8 J u n e 8 J u n e 2 2 F a m i l i e s w i t h D / H H C h i l d r e n $75/Adult, $25/Child $125/Adult, $40/Child Individual Tuition $250/per person $300/per person Indv/Tuition/Lodging $300/per person $350/per person F i n a l r e g i s t ra t i o n d e a d l i n e f o r A L L p a r t i c i p a n t s : J u n e 2 2 Paying participants: This payment section is the grand total for all participants listed on your registration form. Enclosed: Check # M.O.# PO in process with: District/Agency: Purchase Order # Name/Contact for PO: Phone #: Refunds: Must be requested in writing seven days prior to first day of program ( or fax). Payable to: NMSD/ASL Immersion Mail to: New Mexico School for the Deaf Attn: CECT/ASLI 1060 Cerrillos Road Santa Fe, NM to: CECTevents@nmsd.k12.nm.us Questions: Fax: Regular Check-In: 4-7 pm July 23 or July 30 RAC Lobby (follow signage as you enter campus) Late Check-In: For those who cannot check in during times posted above, please call to make special arrangements. Page 1

4 Attending week of (check one): July July 31-Aug 3 Regular Classes Class Level Selection 1) Select only one level per attendee 2) Staff will re-assign students if needed. If lodging at Select only one cottage type per person Attendees (13 and older) Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Talking Signing Meal Selection (required) Please select categories that apply below specific to each registrant listed in far left column. It s recommended that participants with other dietary restrictions bring food to supplement what is provided. Declining Meals Regular Vegetarian Gluten Free Additional important information (specify which individual is associated to this information): Name: Details: Name: Details: Family Classes For families with Deaf/HH children ages 3 and under (list all family members below that will be attending these classes) Select only one level per attendee below If lodging at NMSD Select only one cottage type per person Meal Selection (required) Please select categories that apply below specific to each registrant listed in far left column. It s recommended that participants with other dietary restrictions bring food to supplement what is provided. Adult Attendees (18 and older) Children Attendees (3 and under) Family Level 1 Family Level 2 Talking Signing Declining Meals Regular Vegetarian Gluten Free Additional important information (specify which individual is associated to this information): Name: Details: Name: Details: Please select areas that apply below specific to Children & Teen Program each child/teen (list children/teens below that will be attending the program) Check 1 below Check 1 below If lodging at NMSD Select only one cottage type per person Child Attendee: 18 mo. 11 yrs Teen Attendee: yrs Age Deaf HH Hearing Spoken Sign Both Talking Signing Meal Selection (required) Please select categories that apply below specific to each registrant listed in far left column. It s recommended that participants with other dietary restrictions bring food to supplement what is provided. Declining Meals Regular Vegetarian Gluten Free Additional important information (specify which child or teen is associated to this information): Name: Details: Page 2 Name: Details:

5 Attending week of (check one): July July 31-Aug 3 Release Form Adult Attendee: Parent Guardian (to children listed below) Cell Phone: (for families this is the designated family contact) Adult Attendee: Adult Attendee: Adult Attendee: Adult Attendee: Teens Attending Adult Class: Name: Age: Name: Age: Name: Age: First and Last Name Teen/Child Program 18 mo. to 17 years (list below) NOTE: Related child care service for this program is free and only available for families with D/HH children. Teen/Child 1 Teen/Child 2 Teen/Child 3 Teen/Child 4 Communication 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/Behavioral Supports (i.e., disabilities, special access needs, behavioral concerns, etc) Other Important Information Page 1 of 2

6 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. Release of all Claims I hereby release NMSD, 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 NMSD, its agents and employees, for all personal injuries known or unknown which my child/children, has or may incur by participating in the ASL Immersion. I, the undersigned, have read this release and understand all its terms. I execute it voluntarily and with full knowledge of its significance. 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 program only. My signature below indicates consent for myself, my child/children and family members to be photographed and/or videotaped. 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. Page 2 of 2