Bold fields are required. Your Story
By checking this box, I hereby authorize United Cerebral Palsy (UCP) to use, publish or republish my story and photograph, including my likeness, photographic or video image or the likeness, photographic or video image of my minor children. I also hereby authorize UCP to release personally identifiable information that I share with UCP, such as my first name, hometown, or disability or the first name, hometown or disability of my minor child. UCP will not share your last name, phone or email.
I understand that the purpose of UCP's use or release of the photographic or video images will be to promote disability awareness or initiatives and public education in which UCP is a participant or for use in conjunction with fundraising for UCP's charitable mission. I expressly waive all claims to compensation or damages resulting from UCP's use of the authorized images or information. I represent and warrant that any story or photos that I provide to UCP are not subject to third-party copyright protection, and I waive any copyright claims I may have in them.
I understand that this authorization for Photo/Video/Information Release can be revoked by me at any time by submitting a written request to: Privacy Officer, United Cerebral Palsy, 1825 K Street, NW Suite 600, Washington, DC 20006 or