Photo Release

Date - must be mm/dd/yyyy format * Required
MM slash DD slash YYYY
Name * Required
First Last
Name of Guardian (if individual us under the age of 18)
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email * Required
Name of Your Child's Childcare Program/Provider (if applicable)
* Required
- I authorize Abilities Network, Inc. to photograph me and acknowledge and agree that all photographs become the property of Abilities Network, Inc. and may be used in the sole and absolute discretion of Abilities Network, Inc.
Upload your photos (if applicable)
Drop files here or

Max. file size: 63 MB.

Project ACT’s Funders Include