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This form is used to register a child on the statewide deafblind census, which is conducted yearly by the Ohio Center for Deafblind Education (OCDBE). Children being registered should be from birth through 21 years of age and have combined hearing and vision losses.
Anyone can register a child at any time. If you have more than one child to register, please complete a separate form for each one. Prior consent to disclose information is not required, however, we ask that if you are not the parent, you make the family aware that you are registering their child. All information disclosed on this form is confidential. Only non-identifiable information (such as hearing and vision levels, and etiology) will be shared with our national organization to create a national deafblind child count.
Information you will need to complete the form:
- Parent and school contact information
- Cause of hearing and vision loss (etiology)
- Hearing loss and vision loss levels
Questions concerning this form should be directed to the Census Coordinator, Leanne Parnell, by email at email@example.com or by phone at 800.229.0844 ext. 106.
Thank you for your time and attention.