Braille Tales Application

Please complete this form to enroll in the APH Partners Print/Braille Book Program. The information will ensure delivery of your child’s free print/braille books.

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This field is for validation purposes and should be left unchanged.
Child's Information
Name(Required)
First Last
Birth Date(Required)
Month
Day
Year
Gender
Braille Usage(Required)
- Child is a braille reader or is likely to use braille as his/her future reading medium
- The parent or legal guardian of the child being registered is a braille reader
Agency or organization providing support services
Parent or Legal Guardian Information
Title
Name(Required)
First Last
Shipping Address(Required)
Street Address Address Line 2 City State ZIP Code
County(Required)
Email Address(Required)
Phone Number(Required)
Guardian Status
- I am the child's parent
- I am the child's legal guardian.
- I am a third party filling out application.
If you are the child's legal guardian, please indicate whether you are a grandparent, aunt/uncle, foster parent, etc.
If you are a third party filing out the application please provide a name/title and contact info
Questions contact [email protected].

Braille Tales Application

Child's Information

Parent or Legal Guardian Information