Highlight Submission

highlight submission

* Indicates required field

Name *

First

Last

Phone Number *

Date of Birth (MM/DD/YYYY) *

SCHOOL INFORMATION

School: *

Current Grade: *

Phone Number *

Tell us about it! *

Upload Your Photo *

Max file size: 20MB

SIGNATURES

I authorize permission for my child(ren) to be featured on this organization's web pages. By electronically signing and submitting this form; I consent to the use of my child's photo and story being shared. *

First

Last

Phone Number *

Signature of Parent: *

First

Last

Date: (MM/DD/YYYY) *

Let Me Shine