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Camp Abilities TX 2024 COACH Registration
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* Indicates required question
Name
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Emergency Contact
*
Your answer
T-shirt Size
*
Small
Medium
Large
Extra Large
Required
Gender
Male
Female
Clear selection
Taking Camp for Credit
*
Yes
No
If yes, what university and who is your supervising professor?
Your answer
Days Available
*
Saturday orientation
Sunday campers arrive
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday closing ceremonies; campers go home
Other:
Required
Health Issues
*
Frequent ear infections
Heart defects/disease
Convulsions/seizures
Diabetes
Asthma
High Blood Pressure
Lung Disease
Visual Impairment
Hearing Impairment
Hay fever
Kidney Disease
Chickenpox/Shingles
Measles
Mumps
Ivy poisoning, etc.
Bleeding/Clotting disorder
Allergic to Insect stings
Other:
Required
Allergies
Your answer
Medications and Dosage
*
Your answer
Prior Surgeries
*
Your answer
Other issues you want us to know
*
Your answer
Doctor Name, Address and Phone
*
Your answer
Health Insurance Name and Phone
*
Your answer
Experience with students with visual impairments
*
Your answer
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