Early Explorers Update Contact Information Form

Please complete the form below to update your contact information.

All fields marked with an asterisk(*) are required.

 

Your Preferred Contact Phone Number(s).

Participating Child's Information

Child's Date of birth *
Child's Height
Child's Address
  • If, I am requesting a cane, it is more than six months since a previous request for a white cane.
  • I am submitting this form on behalf of a child who is a participant in the NFB Early Explorers Program.