Hosted by: Missouri School for the Blind
Date: Wednesday, February 18, 2026, from 9:00 am to 3:30 pm.

This digital permission form must be signed by parent/legal guardian and returned by Friday, January 2, 2026. If you have any questions, please contact us at dena.molen@msb.dese.mo.gov. Only contests submitted with a signed permission form attached will be eligible for Braille Challenge Finals.
Student Information

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* 1. Student's First Name:

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* 2. Student's Last Name:

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* 3. Birthdate:

Date

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* 4. Age:

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* 5. Gender

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* 6. Is your student graduating this year? If so, please provide their email address if you would like them to be added to the Braille Challenge Alumni Network.

Parent Information

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* 7. Parent's First and Last Name:

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* 8. Parent's Email:

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* 9. Parent's Telephone Number:

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* 10. Braille Institute Services:

Would you like to be notified about upcoming virtual workshops for students and parents?

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* 11. Would you like to receive more information about free services offered by Braille Institute?

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* 12. PERMISSION

As the parent or legal 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

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