Registration closes January 24th.

This in-person event will be held Saturday February 22nd from 9am - 4pm at WTBBL in Seattle. Registration must be completed by parental/legal guardian and returned by January 24th to WA Talking Book & Braille Library: 2021 9th Ave, Seattle, WA 98121, Attn: Youth Services; by email to erin.groth@sos.wa.gov; or via this electronic form. Only contests submitted with a signed permission form attached will be eligible for Braille Challenge Finals.

Braille Challenge is the only academic competition of its kind held in January through March each year in North America for students who are blind or visually impaired. Braille Institute developed Braille Challenge to motivate students to practice and hone their braille literacy skills, which are essential to academic and employment success. Learn more about the Braille Challenge

Question Title

* 1. Contact Information

Question Title

* 2. Contact Information continued

Question Title

* 3. Assistive Technology
Please answer the below questions to the best of your ability. We use this information to track what devices Braille Challenge participants are using.

Has your student ever used a refreshable Braille Display?

Question Title

* 4. Does your student have regular access to a refreshable braille display or braille notetaker?

Question Title

* 5. If yes, what is the name of the device they use?

Question Title

* 6. Has your student ever paired a refreshable braille display or notetaker to an iPad, iPhone, or Android device?

Question Title

* 7. Name of Teacher of the Visually Impaired

Question Title

* 8. TVI's email address

Question Title

* 9. TVI's Phone Number

Question Title

* 10. Student Contest Level (NOT Grade in School)

Question Title

* 11. Will the student be competing At Grade-Level? Note: Students who compete Below Grade Level will not be eligible for the Braille Challenge Finals.

Question Title

* 12. Please enter your full legal name in the box below to acknowledge the following:
PERMISSION
As the parent or guardian of the contestant, I hereby give permission for the contestant to participate in the upcoming Braille Challenge preliminary contest and, if contestant qualifies, the Braille Challenge Finals and awards ceremony in Los Angeles, CA (collectively “Events”).

LIABILITY RELEASE AND INDEMNIFICATION
In consideration of Braille Institute of America, Inc. (“BIA”) permitting contestant to participate in the Events, I, on behalf of myself, the contestant, our heirs, successors and assigns, hereby waive and release, and agree to indemnify and hold harmless, BIA, its employees, officers, directors, volunteers and agents, including regional coordinators (collectively “Releasees”) 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 the contestant’s participation in the Events.

PHOTOGRAPHIC AND RECORDING RELEASE
I hereby authorize BIA to photograph, videotape, or otherwise record by visual, audio, electronic or manual means, the name and visual likeness and/or voice or other sounds created by the above contestant (collectively “Reproductions”). BIA may use, distribute, permit, copyright, and/or license the Reproductions in any exhibition, display, publication, solicitation, or promotional or educational material, in any format, or on any website including without limitation BIA’s website and social networking websites such as Facebook, Instagram, or YouTube without compensation to the contestant, the contestant’s heirs, successors or assigns.

I have read this permission and release form, and understand that by signing it, I am giving up substantial rights I and/or the contestant would otherwise have to sue or recover damages for losses occasioned by the Releasees’ fault. I sign this permission and release form voluntarily.



Electronic Signature: Parent, Guardian, or 18+ Student

T