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STLRBC 2025 Parent/Guardian Permission

Parent/Guardian Permission is required for all STLRBC participants.
Permission Statement and Liability/ Photographic Release

If you are not the parent/guardian of the participant, please send the link to this survey to the appropriate party:
https://www.surveymonkey.com/r/2025BrailleChallengepermission

PLEASE NOTE: Registration is not complete without signed parent/guardian permission.

* By writing my name in the space below, I hereby give permission for my child to participate in all Braille Challenge events including the regional preliminary contest and, if eligible, the final contest and awards ceremony in Los Angeles, CA. In consideration of Braille Institute permitting my child to participate in Braille Challenge events, I, on behalf of myself, my child, our heirs, successors or assigns, hereby waive and release, and agree to indemnify and hold harmless, Braille Institute of America, Inc., its employees, officers, directors, volunteers and agents, including regional coordinators (collectively “BIA Parties”) from, any and all claims, including claims of negligence, resulting in any physical or psychological injury, illness, damages, or economic or emotional loss, arising from or related to my child’s participation in any Braille Challenge event.

I authorize BIA Parties to photograph, videotape, or otherwise record by visual, audio, electronic or manual means, the visual likeness and/or voice or other sounds created by my child (collectively “Reproductions”).

BIA Parties may use or permit to be used in furtherance of Braille Institute’s mission the Reproductions in any CD, DVD, exhibition, display, publication, solicitation or promotional or educational material or on any website, including without limitation Braille Institute’s website or social media channels, without compensation to my child, my child’s heirs, successors or assigns.

Note: A parent or guardian must electronically sign below. This form cannot be signed by the student unless they are 18 years or older.

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* 1. Parent/Guardian Full Name (constitutes a signature)

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* 2. Parent/Guardian Email

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* 3. Contestant Name

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* 4. Who will be attending the event with your student?

Is the adult attending with the student a:

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* 5. Date

Date
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