LEGO Braille Bricks Kit Request Form

Thank you for your interest in obtaining LEGO Braille Bricks. The bricks are available for free to a specific group of educators who are participating in the education of students who are blind or visually impaired. By accepting these kits, you are agreeing that you will not sell, give away, or lend out your kits to anyone not part of this group.

Ex Officio Trustees, please use the order form in your EOT Profile Page.

Please complete this form to request your LEGO Braille Bricks Kits in the United States. If you are in a different country, contact your country organization here.

When completing this form, you will need to provide your work related e-mail address in order for us to process your order. Shipping method will be Free Matter for the Blind. Please review and agree to the terms of use at the bottom of this page before placing your order.

Choking Warning: This kit is not to be used by children younger than 4 years old.

Name*
First Last
Organization Name*
Job Title*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Requested Number of Kits*
Number of LEGO Braille Bricks kits requested (Note that kits will arrive in multiples of four (4). We will round up your request as needed in order to meet our shipping requirements)
Please enter a number greater than or equal to 1.
LEGO Braille Bricks Terms of Use*
I understand and agree to the LEGO Braille Bricks Terms of Use:*
LEGO Braille Bricks are to stay in the possession of the defined “User Group”, meaning private or public schools, institutes, education centers, etc. in the Territory where one or more blind or visually impaired children receive education and support, including in respect of the Braille system, as well as professional individuals associated with or operating at such schools, institutions, education centers, etc. in connection with such education and support to blind and/or visually impaired children.

"User Group" does not comprise any other private or public legal entities, institutions, organizations, etc. or other individuals, such as parents of blind or visually impaired children, or blind or visually impaired children themselves.

LEGO Braille Bricks will be delivered to the member of the User Group exclusively for its own use in the education and support to blind and/or visually impaired children and that the member is not entitled to sell, lend out or give away any LEGO Braille Bricks to anyone not part of the User Group.

LEGO Braille Bricks are to be used by children ages four (4) and up. Due to choking hazards this product is not to be used with children younger than three (3) years.
User Group Consent*
I acknowledge that I am a member of the User Group*
Comments
This field is for validation purposes and should be left unchanged.

If you need assistance or have any questions please contact us directly: 1-800-223-1839 or email us support@aph.org