White Cane Day Visitor Form - California School for the Blind

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hello,

Thank you for participating in our White Cane Day Celebration! Please fill out this form so that we have an accurate count of lunches to provide on our campus.

Event: White Cane Day celebration

When: Thursday, October 12, 2023

Where:

California School for the Blind

500 Walnut Avenue

Fremont, CA 94536

Schedule:

9:30-10:25 - Outreach student cane decorating
10:05-10:25 - Recess; Outreach students welcome
10:25-11:50 - Assembly and Cane Fashion Show and Award WCD logo winner
11:55-12:30 - Lunch (turkey/cheese sandwiches)
12:30-2:30 - Orientation and Mobility Skills Challenge
2:30-3:30 - Field day

RSVP by Friday, September 29 in order to be guaranteed a free lunch and to order a t-shirt.

T-Shirt Order Form: https://forms.gle/BS1m6k7AmviYUnof9

Please visit our website for more information: https://www.csb-cde.ca.gov/about/events/whitecaneday.aspx

Name / Nombre *

Connection to our school / Vínculo con nuestra escuela *

Teacher of Students with Visual Impairments (TVI) / Profesor para las Personas con Impedimentos Visuales (TVI, por sus siglas en inglés)

Orientation & Mobility (O&M) Specialist / Especialista en Orientación y Movilidad (OyM)

Parent/Family member of a CSB student / Padre de familia/pariente de un estudiante de la CSB

Parent/Family member of a blind/low vision non-CSB student / Padre de familia/pariente de un estudiante ciego/con visión parcial no perteneciente a la CSB

Member of the public / Miembro del público

Other:

Required

If you are a parent/family member of a CSB student, please provide us with the name of your student / Si usted es un padre de familia de un estudiante de la CSB, por favor indíquenos el nombre de su estudiante

What district are you affiliated with? / ¿A qué distrito está afiliado?

How did you hear about us? / ¿Cómo se enteró de nuestra escuela? *

How many adult visitors are in your group? / ¿Cuántos visitantes adultos hay en su grupo? *

Please list the name and titles of all adult visitors in your group / Indique el nombre y los títulos de todos los visitantes adultos de su grupo

Do you have any students coming with your group? / ¿Tiene algún estudiante que venga con su grupo? *

If yes, please answer the following questions about your student visitors / En caso afirmativo, responda las siguientes preguntas sobre los visitantes estudiantiles.

Yes / Sí

Questions or comments for us / Preguntas o comentarios para nosotros

Clear form

Never submit passwords through Google Forms.

This form was created inside of California School for the Blind. Report Abuse

Forms