Current Applicant Information Parent/Guardian Information Health Information Waiver of Liability / Assumption of Risk Responsibility for Personal Property Pick Up Information Disclaimer and Signature Complete First Name First name of the student who will be attending Operation Accelerate. Last Name Last Name of the student that will be attending Operation Accelerate. Street Address Street address of student. Apartment/Unit # City State Zip Code Parent/Guardian Phone Parent/Guardian Email Student Age Rising Student Grade Date of Birth T-shirt Size Day or Overnight Day Only Child will only attend during the day. Overnight Child will attend during the day and stay to sleep overnight. Hearing Aids or Cochlear implants? Yes Child uses a hearing aid or cochlear implant. No Child does NOT use hearing aid or cochlear implant. Does your child use amplification devices (hearing aids or cochlear implants)? Toiletry Needs Does your child hay any special toiletry needs (using the restroom; showering; Feminine hygiene)? If so explain. Mobility Needs Does your child have any mobility needs? (Wheelchair; walker; cane; can’t walk far distances) If yes, explain. What language does your child use to communicate? Language Disclaimer: ASL is the main mode of communication used, interpreters/transliterators will not be provided for ASL to spoken English, only spoken English to ASL