Your name:
Email Address:
Mailing Address:
City:
State:
Zip:
Telephone:
Fax:
I am over 18 years of age
The image I'm
sending is a picture of me.
The
image I'm sending is a picture of my child,
of whom I am the legal guardian.
The
image I'm sending is not of a person, but I own the picture.
File Upload
(Choose the picture file to send
with this form.)
Caption / Story
(Enter whatever text you'd like
us to publish with your picture,
up to 200 characters. We do
recommend for children's safety,
to never post the full name of a
child online.)
Submitted by
(Enter the name of the person
submitting the photo,
exactly as you want it published
online.)
e.g., Mary Jones,
Mom, Dad, Grandma, etc.
By signing below, I certify that the information
provided within
this form is accurate and hereby give permission
for the
uploaded image to be posted on the Central Florida
Parent Center's website, and waive any rights of
compensation or ownership
thereto.
In addition, Central Florida Parent Center has my permission to
utilize
my uploaded image for training materials
(such as workshops)
and for marketing materials (such as
brochures).
Online Signature
(Enter your full name):
