College and Career Readiness Retreat

for High School Students Who Are Deaf and HOH

Hosted By

Join us for the 1st Annual all inclusive retreat designed to guide students who are deaf and hard of hearing through the college and job application process. The weekend will include fun activities and informational workshops, including: Motivational Speaker Interest Testing A College Timeline College Options How to Pay for College Understanding Vocational Rehabilitation Services Interview Skills and Best Practices Understanding SSI and the Benefit of working Bonfire Ice Breakers Team Building Games

FREE!

FREE!

Friday, September 27th 4:00pm Sunday, September 29th 10:30am Camp Hillmont-975 Hillmont Camp Rd. White Bluff, TN
Retreat is FREE for all high school students. One parent or adult is invited to attend with a group of 4 or more students for free; otherwise the cost is $79 for one adult (pay with check or money order at retreat). All accompanied adults will have separate lodging. Students will stay in student lodge with screened staff and volunteers. Transportation will be offered to and from Camp Hillmont from two locations in Nashville: Bridges Radisson Hotel Nashville Airport (TSD drop off location) 935 Edgehill Ave 1112 Airport Center Drive Nashville, TN 37203 Nashville, TN 37214 Pick up at will be at 3pm September 27th, and drop off will be at same the same location at 11:30am

www.hillmontcamp.com

Please complete the two page registration form and return in via email to andie.scott@oasiscenter.org or mail to: Oasis Center Attn: Andie Scott. 1704 Charlotte Ave Suite 200. Nashville, 37203 For questions please contact: Andie Scott at andie.scott@oasiscenter.org or 615-

College and Job Readiness Retreat Registration Form

Students Name _________________________________ Age ______ Birth Date ______________ School ________________________________________ Grade _____ Gender? Male or Female Identity: ___ Deaf ___ Hard of Hearing /Accommodations: Interpreter____ Closed Caption___

Parent/Guardian Name(s) ____________________________________________________________ Home Address ____________________________________ City __________ State ____ Zip _____ Day Phone _________________ Eve Phone _________________Cell Phone _______________ Email ________________________________________ Emergency Contact: ___________________________________ Relationship __________________ Day Phone __________________ Eve Phone _______________________ Cell ________________ Physicians Name ________________________________________ Phone ___________________ Health Insurance ________________________________ Policy or Group ID No. _______________ __________________________________________________________________________________ Transportation: Do you need transportation to and from the Retreat from Nashville? Details on info sheet. Yes I need transportation from Bridges (935 Edgehill Ave, Nashville) pick up and drop off location_____ Yes I need transportation from the Radisson Hotel Nashville (1112 Airport Center Dr. Nashville)_______ No thank you, I will provide my own transportation_______ Medical Information: Does student have any other health condition, aside from hearing loss, which we need to be aware of in the course of this event (vision impairment, seizures, allergies, etc.), or any other specific need? If yes, please list and explain:_____________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Name of Medicine Dosage/Times per day

Emergency Medical Authorization/Liability Release/Consent

This medical authorization is necessary in of an emergency during the course of this event. STARS, Bridges, and Oasis waive all liability for appropriate medical care if you choose not to authorize your permission. I hereby give permission to the physician and clinic/hospital staff selected by STARS, Bridges, or Oasis staff to secure medical treatment in the case of an emergency. I understand the risks involved during the Retreat activities and I accept full responsibility for my childs participation in those activities. This medical care shall include, but is not limited to: examinations, treatments, immunizations, injections, anesthesia, surgery, and other procedures. This permission is conditioned upon the understanding that in the event of the need for hospital services and/or major surgery, said person will use all reasonable efforts to contact the undersigned. Failure in such efforts, however, shall not prevent the provision of emergency treatment necessary for the best interest of the health and life of the said participant. For and in consideration of said covenants, the participant and the undersigned hereby release, acquit and covenant to hold harmless the said STARS, Bridges, and Oasis and all other persons, firms and corporations from all claims, damages and causes of action of whatever nature which may accrue to the said participant or the undersigned, their heirs, executors, administrators and legal representatives and assigns, arising out of any of the above procedures. __________________________________________________________________________________ Parent/Guardian Signature Date Disclosure and Responsibility Statement I have answered all the questions to the best of my ability and have disclosed all information requested and necessary. I take responsibility for providing all medications that have been prescribed, and have acknowledged any special needs that my child may require in the interest of their safety and well-being while attending Camp Hillmont. ___________________________________ Parent/Guardian Signature __________________ Date

Public Relations Authorization I hereby give permission for photographs & film footage to be used in promotional activities and/or the public relations of STARS, Bridges, or Oasis which relate or include my child and his or her peers. __________________________________________________________________________________ Parent/Guardian Signature Date

Transportation Release- Please complete if transportation is needed to and from the Retreat. My child, ____________________________________, has my permission to be transported by staff from (please check)________ 935 Edgehill Ave, Nashville or______ 1112 Airport Center Dr. Nashville on Sept 27th, 2013at 3pm too Camp Hillmont and returning to the same location September 29 th, 2013 at 11:30am. My child will use a seatbelt at all times while traveling on Oasis vehicles. ___________________________________ Parent/Guardian Signature ________________ Date