Woodworking Workshop Registration Form * These fields are required.Interested in woodworking? Want to learn the fundamental skills of woodworking? Join others with the same interests at the Enchanted Hills Camp. This workshop is for beginning to intermediate woodworkers. The Workshop features four full days of instruction in the beautiful hills outside Napa. This will be an introduction to power tools, measuring with a click rule, gluing, screwing, nailing, and a basic overview of how all these things work. Individual tutoring will be available for beginning woodworkers to give them a broad familiarity with woodworking machines and tools. We all started woodworking somewhere, and this is a great opportunity to begin gaining the skills, confidence and enjoyment of woodworking. Spouses, Companions and Partners are welcome. Registration limited to 10 participants. Please Note: ALL campers must be able to take care of their own daily needs with little assistance. Camp Session Please select the session you wish to attend: Session * Session I: Tuesday, August 13 - Saturday, August 17Session II: Monday, August 19 - Friday, August 23Contact Information Camper's First Name * Camper's Last Name * Email Primary Phone * Phone Type * --None--HomeMobileFaxWorkTTY/VP Do you have a roommate preference? * --Choose One--YesNo If yes, who do you desire as your roommate? Please note that these are requests and we will attempt to fulfill them, but we do not guarantee requests. These requests are honored by availability.Mailing Address Street * City * State --None--AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming Zip * Country * United StatesAfghanistanAland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State ofBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, the Democratic Republic of theCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, the former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishWallis and FutunaWestern SaharaYemenZambiaZimbabweEmergency Contacts Emergency Contact Name * Emergency Contact Relationship * Emergency Contact Phone * 2nd Emergency Contact 2nd Emergency Contact Relationship 2nd Emergency Contact Phone Vision and Hearing Info What is your level of vision?* * --None--Low Vision (not legally blind)Legally BlindTotally BlindNot Blind/Low Vision Primary Cause of Vision Loss * -None--AlbanismCataractsCMVCVIDetached RetinaDiabetic RetinopathyGlaucomaLeber's Congenital AmaurosisMacular DegenerationOptic Nerve AtrophyOptic Nerve HypoplasiaRetinitis PigmentosaROP/RLFStargardtsStrokeTraumaUshers SyndromeUnknown CauseOtherN/A Age of onset * If partially sighted, please describe your functional vision. How do you prefer to access print material? * --Choose One--BrailleTapeLarge PrintEmail Level of hearing * --None--Hard of hearing - understands speechHard of hearing - cannot understand speechTotally DeafNot deaf or hard of hearing Do you use hearing aids? * --Choose One--Left earRight earBoth earsNone For communication, which do you use? * --Choose One--Sign LanguageFinger SpellingVerbalOther Communication/Speech * --Choose One--VerbalNon-Verbal If you are non-verbal or have another method of communication, please describe. Additional Notes about Vision/Hearing Health Info Are you allergic to any prescribed or over-the-counter medications? * --Choose One--YesNo If yes, what are they? Describe your reaction and how you have been treated in the past. Do you have any medical conditions or disabilities other than blindness? Please include information about medications or treatment that we should be aware of and how you have been treated in the past. * Do you have any special considerations (medical or otherwise) or accommodation needs that we may need to be aware of? If so, please describe them. * Are you allergic to any foods? * --Choose One--YesNo If yes, what are they? Describe your reaction you had and how you were treated in the past. Do you have any dietary restrictions that we should be aware of? * Mobility Are you an independent traveler? * --Choose One--YesNo Which do you use? * --Choose One--Battery WheelchairNon-Battery WheelchairSupport CaneWhite CaneHuman GuideGuide DogNoneOther If you use more than one, choose the other: --Choose One--Battery WheelchairNon-Battery WheelchairSupport CaneWhite CaneHuman GuideGuide DogNoneOther If you are a wheelchair user, can you use your chair on unpaved trails? * --Choose One--YesNoNot a Wheelchair User If you are a wheelchair user, can you transfer independently? * --Choose One--YesNoNot a Wheelchair User Do you tire easily? * --Choose One--YesNo If yes, please explain: Can you participate in walks up to an hour long? * --Choose One--YesNo Woodworking Questionnaire What made you interested in learning woodworking? * Do you have any previous experience with woodworking? * --Choose One--YesNo What is your level of woodworking experience? * --Choose One--BeginnerIntermediateSkilled What types of items have you made in the past? * What types of items are you interested in making? * How confident are you around woodworking tools? * --Choose One--Not ConfidentSomewhat ConfidentMostly ConfidentExtremely ConfidentDemographic Information Please complete all questions below. If you choose not to disclose some of this information, simply select 'Declined' from among the drop-down options. This information will NOT affect eligibility. Demographic information is important for grant and funding applications, which assist in defraying costs for your attendance. All responses will be kept confidential and only reported in the aggregate. Thank you! Birthdate (mm/dd/yyyy) * Sexual orientation/Sexual identity * --Choose One--Straight / HeterosexualBisexualGay / Lesbian / Same-Gender LovingQuestioning / UnsureOtherDeclined If other, please specify. Gender * --Choose One--MaleFemaleTrans MaleTrans FemaleGenderqueer / Gender Non-binaryOtherDeclined Sex at birth * --Choose One--MaleFemaleDeclined Ethnicity * --Choose One--AfricanAfrican AmericanAlaska NativeAsian OtherCambodianCaucasianChineseEastern EuropeanFilipinoJapaneseKoreanLaotianLatinoMiddle EasternNative AmericanPacific IslanderVietnameseMulti-EthnicOtherDeclined Primary language * EnglishArabicASLCantoneseCzechDanishDutchEnglishFrenchGermanGreekHaitian CreoleHindiHmongHungarianItalianJapaneseKoreanMalay/IndonesianMandarinNorwegianNepaliPersianPolishPortuguesePunjabiRomanianRussianSomaliSpanishSudaneseSwedishTagalogThaiTurkishUkrainianVietnameseOtherDeclined Type of residence * --Choose One--Assisted Living CenterHomelessLong Term Care FacilityPrivate ResidenceSenior Living/Retirement CommunityShelterSROOtherDeclined Number of people in household * --Choose One--12345678910 Monthly household income * --Choose One--0 - 1,0001,001 - 2,0002,001 - 3,0003,001 - 4,0004,001 - 5,0005,001 - 6,0006,001 - 7,0007,001 - 8,0008,001 - 9,0009,001 - 10,00010,001 - 11,00011,001 - 12,00012,001 - 13,00013,001 - 14,00014,001+Declined Highest level of education completed * --Choose One--No Formal SchoolingElementary (grades 1 - 8)Secondary, no high school diploma (grades 9 - 12)High School or Equivalency CertificatePost Secondary Education/Some CollegeBachelors DegreeMasters Degree or HigherDid Not Report Are you a veteran?** * --Choose One--YesNoDeclined * Legal blindness is a level of vision loss that has been legally defined to determine eligibility for benefits. The clinical diagnosis refers to a central visual acuity of 20/200 or less in the better eye with the best possible correction, and/or a visual field of 20 degrees or less.** A veteran is a person who served in the active military, naval, or air service, and who was discharged or released there from conditions other than dishonorable.Transportation Let us know how you will get to and from camp. Getting TO camp: I will get to camp by private car I will take a charter bus ($25 one way or $40 round trip) -- If you are taking a chartered bus, select an option below-- San Francisco bus departs at 1:00PM from the LightHouse, 1155 Market Street Berkeley bus departs at 1:30PM from Ed Roberts Campus, 3075 Adeline Street Evans Airporter departs from San Francisco or Oakland International Airport. Evans Airporter then arrives at 4075 Solano Avenue, Napa. From here Enchanted Hills Transportation departs for camp at 2:00PMGetting back FROM camp: I will leave camp by private car I will take a charter bus ($25 one way or $40 round trip)-- If you are taking a chartered bus, select an option below-- San Francisco bus arrives at 12:30PM at the LightHouse, 1155 Market Street Berkeley bus arrives at 11:30AM at Ed Roberts Campus, 3075 Adeline Street Enchanted Hills Transportation departs camp at 10:00AM for 4075 Solano Avenue, Napa. From here Evans Airporter will then take you to San Francisco or Oakland International Airport. Payment Info Please note: YOUR APPLICATION WILL NOT BE PROCESSED WITHOUT PAYMENT AND COMPLETE APPLICATION Please check the box of your chosen answer.(Pay by credit card via Sequence Guilder, the Enchanted Hills Camp Admin Assistant, at (415) 694-7310) Credit card payment. Mailing a check or money order. Other (please call (415) 694-7310 or email email@example.com to discuss.)Send payments to: Enchanted Hills Camp Application LightHouse for the Blind and Visually Impaired 1155 Market Street, 10th Floor San Francisco, CA 94103 If you have questions, please contact: Enchanted Hills Camp Admin Assistant at (415) 694-7310Camp Fees* $350 Woodworking Camp Fee Charter Bus Fee (if taking an EHC bus) ($25 one way, $40 round trip) $150 Spouse, Companion, Partner Fee *All cancellations are subject to a $50 non-refundable administration fee. Cancellations received 30 days or more prior to the start of session will be refunded, less the administration fee. Cancellations received less than 30 days prior to the start of session are not refundable.