Hearing Accessibility Kit Selection Form
Choose your items and provide your contact details to receive assistance.
Select up to 8 regular items for your kit:
*
Dry-erase communication board
Dry-erase markers and eraser
Large-print notepad and pens
Flashing light doorbell
Vibrating alarm clock
Pocket notebook for communication
Laminated emergency communication cards
Hearing protection earmuffs
Captioned phone information guide
Portable flashlight
Pill organizer with visual labels
Reusable communication cards
Small whiteboard for travel
Select one premium item for your kit:
*
Bed shaker alarm attachment
Bluetooth speaker for amplified sound
LED message writing tablet
Phone/tablet stand for communication
Assistive listening device
Full Name
*
First Name
Last Name
Recipient Age and Interests
*
Age and gender
Favorite color, animal, and character
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Preferred method of contact
*
Phone
Email
Text
Submit Request
Should be Empty: