Future Reflections Winter/Spring 1998, Vol. 17 No. 1
Sponsored by the NOPBC
City: State: Zip:
Home Phone:=20 E-Mail address:
Name of school:
Grade /grade level:
1. Description of vision, any other disabilities:
2. List one sport or physical activity in which you participate or have participated:
3. How long have you participated in this?
4. How did you get started?
5. Describe any special adaptations you use:
6. Have you competed in any events, won events, won trophies /awards, etc? Describe:
7. What advice would you give to other blind kids about this sport/activity?
[ ] Yes, you may give my name, address, and phone number to other parents who would like to contact me for more information.
[ ] No, you may NOT give my name, address, and phone number to others. Information from this survey may be used only for articles and other public information purposes. I understand that our names and the state we live in may be used for this purpose.
Mail to: Crystal McClain 1070 Township Road 181 Bellefontaine, Ohio 43311.