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Iowa Library for the Blind and Print Disabled

library@blind.state.ia.us

524 4th Street Des Moines, IA 50309

515-281-1323

Section 1 of 6 in this document

2026 Iowa Regional Braille Challenge Student Permission Form

Hosted by: Iowa Library for the Blind and Print Disabled - 524 4th Street, Des Moines, IA 50309

When: Saturday, February 14, 2026 - Snow Date Saturday, February 21, 2026

This form must be signed by a parent/legal guardian and returned  by January 23, 2026. Please submit via Seamless Docs or by email to Karen Cunningham at karen.cunningham@blind.state.ia.us. Only contests submitted with a signed permission form attached will be eligible for Braille Challenge Finals.

Student Information

Student's Full Name

Student's Home Address

Student's Birthdate

Date Picker

Student's Gender

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

Student's T-Shirt Size

Adult attending with student:

Section 2 of 6 in this document

Parent/Guardian Information

Parent/Guardian's Full Name

Please complete the short survey below regarding your student's Braille Challenge contest level.

Please select your student's Braille Challenge contest level below.  Noted next to each level is the equivalent braille learning grade level. 

Please choose one. Note: All contests are in UEB format only.

Is the student:

Students who take a contest below their academic grade level or test at the Foundational level are not eligible to attend the Finals.

Section 3 of 6 in this document

Braille Institute Services

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 RELEASEI 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

Choose how to sign
Section 4 of 6 in this document

Student Interest Survey - Tell Us About Yourself!

What is your favorite...?

Section 5 of 6 in this document

Lunch will be provided for participants and families during the Braille Challenge.

A block of rooms has been arranged at Homewood Suites by Hilton, located at 2455 Southeast Creekview Drive, Ankeny, IA 50021.  Reservations are available to families of the Braille Challenge at no cost.  

Please indicate below if you need a hotel reservation and for which nights:

A $50.00 stipend is available to families who are attending the Braille Challenge who live more than 50 miles from Des Moines.

Will you need the stipend?

Please submit/return by January 23, 2026