Show Us Who You Are - Faces of CP

Welcome! You’re the face of CP.

Part of an 18-million-strong global community. So share your story, your proudest achievements, your biggest challenges, what you’d most want people to know about you.

Name*
First Last
Email*
Age*
Brief Introduction*
Full Story
Share what you'd like about yourself. Here are some questions to guide you if you need them: What do you wish people knew about cerebral palsy? What are some of your interests or hobbies? What type of cerebral palsy do you have? How old were you when you were diagnosed?
Are you inside the United States?*
- Yes
- No
Which state are you in?*
Which country are you in?*
Images*
Drop files here or

Max. file size: 256 MB.
If we post your story on social media, we'd love to tag you. What are your Instagram and/or Twitter usernames?
How did you hear about Faces of CP and CPARF?
Do you want to receive occasional newsletters and email from CPARF?*
- Yes
- No
Do you want to learn more about how to raise funds for CPARF?*
- Yes
- No
Parent or Guardian Details
Parent or Guardian's name
First Last
Email of parent or guardian*
Phone of parent or guardian
Agreements
Consent*
By signing this form, I grant permission to Cerebral Palsy Alliance Research Foundation (“CPARF”) and its affiliates, its agents, and its employees, to use the submitted photograph(s) and/or video(s) in printed, electronic, television, and digital media for its campaigns in the United States and globally, including Faces of CP, STEPtember, and any other future fundraising, marketing, and advertising campaigns or initiatives. I understand that CPARF will not use my photo(s) or video(s) in slanderous or misrepresentative ways.

Additionally, I waive the right to inspect or approve the finished photograph(s) or video(s) or printed or electronic matter that may be used in conjunction with image(s) or video(s), whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph(s) or video(s). CPARF has the discretion to decide whether to use the photograph(s) or video(s).

By signing this form, I acknowledge that I fully understand the contents, meaning, and impact of this release.
I agree to the terms and privacy policy.
By checking this box, I permit CPARF to shorten or paraphrase any of the quotes given above.*
I permit CPARF to shorten or paraphrase any of the quotes given above.

Parent or Guardian Details

Agreements