Youth Services Event Registration

Registration Requirements

This form is for registering youth participants (ages 8–18) in MCB Youth Services events.

Eye report required: An eye report from a doctor or organization (such as the St. Louis Society for the Blind or Delta Gamma) must be attached. The report must be dated within the last 12 months and include the participant's name, date of birth, and diagnosis — along with the name, address, and phone number of the doctor or organization. You may submit using the Youth Medical Summary form or by mailing/emailing documentation to MCB.

Required field

Event Information

Event Name

Event Date

Participant Information

Participant First Name

Participant Last Name

Age

School

Parent / Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Email Address

Contact Phone

Accessibility & Health Information

Level of Vision Loss

Mobility Aids Used

Sighted Guide

White Cane

Guide Dog

Health Concerns or Food Allergies

How did you hear about this event?

Paper Form

Download PDF Form

Mail to:

Missouri Council of the Blind
5453 Chippewa Street
St. Louis, MO 63109

Eye Report Required

Submit vision documentation separately:

Youth Medical Summary Form

Questions?

(314) 832-7172

(800) 342-5632

moblind@moblind.org