Educational and recreational activity Name *Surnames *Telephone numbersEmail *Town *How is your living area considered: *UrbanRuralWhich category best describes you? You can check more than one.Father, mother of child with hearing loss/deafProvider of services for children with hearing loss/deafOtherOther:Please tell us in which town you live and in which town you work.My education is: *Elemental schoolMiddle SchoolHigh schoolVocationalPost secondaryOther:If you answered "Other" in the previous question, specify your educational level:Please write down the name of the school of the child with hearing loss. If you are a professional, write down your workplace:My race is: *WhiteAfrican AmericanNative AmericanAsianTwo races or moreI don't want to disclose itOtherOther:My ethnicity is: *Hispanic or LatinaNot Hispanic or LatinoI don't want to disclose itAge of the person with hearing loss I care for or work with: *0-3 years4-9 years10-12 years13-21 yearsDoes not applyOtherOther:The child has hearing loss and another condition *Reasonable accommodation for the adult:Reasonable accommodation for children:How many children will you bring?Diet restrictionsI agreeI understand that the activity will be in person at Terra Campestre and Villa Campestre, Guaynabo, Puerto RicoSend
