National Federation of the Blind of Texas

San Antonio Chapter

Online Braille Class

Registration Form

Now that you understand the importance of Braille literacy and how Braille can be of benefit to you as a blind person in many ways the next step is to register for our up-coming Braille class. There are two ways to do this. First you can register using our online registration form or use our Downloadable Braille Class Registration Form and submit it to us by email or snail mail to enroll in this life-changing activity.

Email Form Submission

If registering via email send your completed form to Mary Donahue at:

braille@satx.rr.com

Online Braille Class Application

If you submit your application online it is important to gather all pertinant information prior to entering the required data in to the form. Once begun you must complete all form fields. You cannot begin entering the form data and submitting additional information at a later time. All of the form entries will be lost once you exit the application. For this reason we strongly encourage blind adults, blind children and their parents to gather all required information prior to filling out and submitting the online application.

Student Profile

Student's First Name:	Student's Last Name:
Gendor Gendor: Male Female	Student's Birth Date	Student's Grade Level Preschool Kindertgarten 1 2 3 4 5 6 7 8 9 10 11 12 College

The following questions should be answered if a blind child or teen are enrolling. Parents are encouraged to enroll as well. Blind children and teens may still take the class should their parents choose not to participate.

Parent's Information

First Name of Parent or Guardian	Last Name of Parent or Guardian
Address Line One
Address Line Two
City:	State: Texas	Zip:
Home Phone Number:	Alternate Phone Number:	Email Address:
Please clearly describe any medical conditions or disabilities the student has, including cause of blindness, visual functioning (if any), any medications that will need to be taken during the event, and any other special considerations (medical or otherwise) of which we need to be aware.

Reading Media and School Information

Student's Reading medium: Braille Large Print Both	School Name:
Has the student ever participated in a blindness skills program? NO Yes	If so, where and when?
On a separate sheet, please write a paragraph describing three goals you have set for yourself, and why these goals are important to you. (To be completed by the student) If registering online you can use the text box below to include this information.

Parent Profile

Name of Parents/Guardian who will be participating in this class with this student:	Adult's Reading medium: Braille Large Print Both
Please describe any special considerations (medical or otherwise) of which we need to be aware regarding the adults accompanying this student:
Register for the NFB of Texas San Antonio Chapter Braille Class

** Please note the following:

Additional Information

For more information contact Jose Martinez at (210) 651-2379 or by email at:

SanAntonio@nfb-texas.org