Blind Parent Gift Shower Entry Application

The National Federation of the Blind of New Jersey would like to celebrate blind parents in the first blind parent gift shower. Parents who are blind or visually impaired, live in the state of New Jersey, and have at least one child under the age of 10 are encouraged to complete the below application. Please note that couples who are both blind with children can submit two separate entries.

 All individuals who complete an application will be notified of the prize drawing event to occur virtually on Wednesday, September 13 at 7PM. You do not need to be present to win. However, there are special gifts and opportunities offered to those who do attend the winner selection.

If you have any questions about this application or the process, please email nfbnjmembership@gmail.com.

 

 

Sign in to Google to save your progress. Learn more
Untitled Title
First and Last Name *
Email: *
Phone: *
Street Address: *
City, State, Zip: *
What is your marrital Status? *
Required
Select all of the methods you prefer for communication. *
Required
What is your eye condition and/or your level of vision? *
How did you hear about the blind parent gift shower? *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy