Illuminating Hearts Share Your Stories

Submission and release form

Your Name(Required)
Care Setting(Required)

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Accepted file types: docx, doc, rtf, txt, jpg, jpeg, png, gif, tif, tiff, webp, Max. file size: 20 MB, Max. files: 5.
    If you have your stories saved in a separate file, upload them here along with images you’d like to share.
    Terms and Conditions(Required)

    If option A, B, or C (below) is selected, I hereby grant to Activity Connection.com LLC and its agents and employees the absolute and irrevocable right and unrestricted permission to either digitally, in print, or in any other medium now and hereafter known, for any purpose whatsoever including, but not limited to publication, promotion, illustration, advertising, or trade, the photographs and/or video images taken of me, or my work, or in any setting which I may be included, or of persons-in-care on whose behalf I am submitting; to alter the same without restriction; and to copyright the same. I also grant permission to use my statements that were given during form submission, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation.

    Additionally, if option C is selected (below), I hereby grant to Activity Connection.com LLC and its agents and employees the absolute and irrevocable right and unrestricted permission to use, re-use, display, distribute, transmit, publish, re-publish, copy, either in whole or in part, any photographs or videos images taken that may include the Corporate Branding, logomark, entity name, address and statements for Illuminating Hearts, a joint project by Activity Connection and NAAP, celebrating the impactful work of activity professionals in senior living, for the purpose of publicity without restriction. Ownership of our community waives all rights to any compensation.

    Please specify the level authorization you approve allowing us to reproduce (post) any submitted physical likenesses, names, information and\or statements:(Required)
    This field is for validation purposes and should be left unchanged.