IMPORTANT PHONE NUMBERS

Louisiana Center for the Blind: 800-234-4166 (Monday-Friday, 8:00 a.m.-5:00 p.m. central)

Eric Guillory: 318-245-2157 (evenings and weekends)

Bre Brown: 304-203-3832 (evenings and weekends)

Apartment Manager: 318-497-1567 (evenings and weekends)

WHEN TO BE HERE:   Sunday, July 23, 2017 between 1:00 and 4:00p.m.

WHERE TO BE:            LCB Education Center--Conference Center

                                        504 E. Mississippi Ave.

THINGS TO BRING

  • Bedding for single bed (sheets, pillowcase, pillow, blanket, bedspread)
  • Towels and washcloths (at least 5 of each)
  • Bathing suit
  • Casual clothes (7-10 outfits)
  • At least one dress outfit    
  • Comfortable shoes (tennis are mandatory; other shoes such as flip-flops and sandals are fine for indoor environs)
  • Dress shoes
  • Toiletries (Soap, deodorant, shampoo, brush, toothbrush, toothpaste)
  • Any medications (clearly labeled)
  • Sunscreen
  • Comfortable, wide-brim hat for when in the sun (not mandatory but suggested)

PLEASE NOTE: Radios, MUSIC players, clocks, notetakers, stuffed animals, favorite games, etc. are permitted; however, the Louisiana Center for the Blind will not be responsible for any loss or damage. The Louisiana Center for the Blind will cover all necessary fees for activities. Although children may wish to bring spending money ($10 to $40), it is completely optional.

 

T-shirts, blue jeans, shorts, or sandals are all permissible as casual attire when in classes. However, care should be taken that chosen outfits are not inappropriately revealing or do not contain explicit or otherwise inappropriate messages. The importance of having comfortable tennis shoes for cane travel and other walking activities cannot be overstated.

 

Permission to Particpate in Buddy Program Activities
I hereby grant permission for my child to participate in all activities of the Buddy Program operated by the Louisiana Center for the Blind. This includes all activities on and off the premises. I understand that vehicles and adult supervision of my child will be provided by the Louisiana Center for the Blind during all activities. I understand that the Louisiana Center for the Blind is not liable for any injuries to my child. This permission covers all activities between July 23-August 12, 2017. *
Student Information Form
Include Street, City, State and Zipcode
Have you ever been away from home before? *
Do you have any allergies/dietary restrictions? *
Can you swim? *
Are floatation devices required? *
Previous Training
Have you had training in... *
Check all that apply.
If you use a notetaker, please indicate which notetaker(s) you have used and your experience level with the device(s)?
Cane Use *
Please let us know when you use your cane. (Check all that apply.)
Additional Information
STUDENT CELL PHONE POLICY
Please provide the student's cell phone number.
By checking below, I indicate my agreement with the aforementioned cell phone usage policy. *
AUTHORIZATION FOR EMERGENCY MEDICAL CARE
In the event of a medical emergency, I/We hereby authorize the provision of medical and/or surgical treatment by an appropriate medical clinic, hospital, or private practitioner for the above-named child. I/We authorize any of the following to authorize such provisions of emergency treatment on said minor's behalf if we are unable to be reached. *
Please provide their full name; their relationship to the student; their address; and applicable contact phone number(s)--indicating work, home, or cell.
Please provide their full name; their relationship to the student; their address; and applicable contact phone number(s)--indicating work, home, or cell.
In the event none of the above can be contacted within a suitable period of time, I authorize the staff of the Louisiana Center for the Blind to authorize emergency treatment on said minor's behalf. Further, I/We understand that the Louisiana Center for the Blind agrees to inform me/us as soon as possible of the need for and result of any emergency treatment provided under this consent. *
Medical Records
NOTE: Upon request, the Louisiana Center for the Blind will assist students in the location and accessibility of medication and treatment.
Street, City, State, Zipcode
Does your child take any medication on a regular basis? *
If your child takes medications regularly, please submit a numbered list below with the following information: Name of Medication; Dosage & time taken; Reason for Medication; whether or not child can administer independently; Additional Comments.
Please continue list if needed.
Authorization to Administer Over the Counter (OTC) Medications
As the parent/guardian of a Buddy Program 2017 student, I hereby authorize the Louisiana Center for the Blind to administer the following over-the-counter medications to my child as needed. *
Photo & Video Consent Form
The undersigned does hereby authorize the Louisiana Center for the Blind (LCB) to photograph/video my 2017 LCB Buddy student.. *
The undersigned grants the Louisiana Center for the Blind (LCB) permission to use and display said media in any publication, multimedia production, display, advertisement or World-Wide Web publication. *
The undersigned agrees that the Louisiana Center for the Blind (LCB) may use name, likeness, or biographical information supplied by the undersigned. *
The undersigned releases and forever discharges the Louisiana Center for the Blind (LCB), its agents, officers and employees from any and all claims and demands arising out of or in connection with the use of these photographs/images, including but not limited to, any claims for invasion of privacy or defamation. *