Louisiana Center for the Blind Buddy Program

Buddy Program - Application

This summer, the Louisiana Center for the Blind will sponsor one session of the “Buddy” Program from July 18-August 7.

We are looking forward to working with your child this summer. We know it will be a memorable experience for both you and them. If you are interested, please complete this application by April 9th or call Eric Guillory at
800-234-4166.

Due to limited space, we cannot guarantee that every applicant will be granted enrollment.

Please note that the fee for students not from Louisiana attending the program is $1,000-which is all-inclusive save for transportation to and from the program.

Child's Name:
Parent's Name:
Mailing Address:
City:
State:
ZIP Code:
Email Address:
Telephone Number:
Child's Age:
School:
Current Grade Level: (for 2009-2010 school year)
V.I. Teacher:
Does your child use large print or magnification devices?:	Yes No
Does your child use a cane?:	Yes No
Does your child know Braille?:	Yes No
	Contracted Uncontracted
Cause of Blindness:
Visual Acuity:
Does your child have any other disabilities or medical conditions?:
Hobbies:

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