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41 days, 12 hours, 25 minutes until NFB National Convention in Dallas.

BELL Program Student Registration

Youth Programs

Register your child now for BELL camp to be held this summer in Abilene, Austin, Beaumont, and Houston. BELL is Braille Enrichment for Literacy and Learning. The BELL program is a fun way to expose blind children to confident Braille readers and leaders in their community.

Complete the online form and mail or fax the Braille Registration Packet forms to NFB of Texas.

Enjoy our video from the 2011 BELL camp in Austin!

Student information

Last name: *

First name: *

Birth date: *

Current grade level: *

Are you a US citizen?: *

Yes

Address: *

City: *

State: *

Zip code: *

Home phone:

Cell phone:

E-mail address:

Parent/Guardian information

Name(s): *

Address:

An address is only required here if different from above.

City:

State:

Zip code:

Home phone:

Cell phone:

Work phone:

E-mail address: *

Emergency contact information

Name: *

Primary phone: *

Secondary phone: *

E-mail address: *

Relationship to student: *

School information

Name of school:

School address:

City:

State`:

Zip code:

Teacher of blind students:

E-mail address:

Miscellaneous information

For identification and safety purposes, we would like all students to carry a white cane for the duration of the program. If your student does not have a long, white cane, we would be happy to provide him/her with one.

Does your student have a white cane?: *

Yes

If no, what is your student's height?:

The National Federation of the Blind makes several blindness related publications available. Check any of these you would like to receive

Permission

There will be a fee for attending BELL Camp, however financial assistance is available to those with special needs.

I give permission for my son/daughter to participate in all NFB BELL Program events and activities except those noted under “Activity Restrictions” on the Health History form. I further understand that the National Federation of the Blind, its sponsors, and/or its partners are not liable for items lost or damaged during the course of the event.

Signature of parent/guardian: *

Attachments:

BELL Registration Packet (Please download and complete these forms to complete your registration.)

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