Thank you for sharing your story!

Thank you for submitting your clear mask photo and story to Rebecca! We look forward to sharing how The IC’s accessible mask giveaway impacted you. However, to do that, The Independence Center and the Pikes Peak Community Foundation need your permission.

Giving permission is easy!

First, click on the links below to read the HIPAA and photo release forms.

Next, complete the form below. Make sure you check the boxes  that verify that you have read and agreed to the terms of the release forms.

Finally, click the submit button!

Bonus: To thank you for your help, you’ll also be entered for a chance to win one of four $25 gift cards to Amazon!

Permission Form

Complete the form below to give The IC and Pikes Peak Community Foundation permission to share your story/photo(s). Please provide a phone number or email so that we can contact you with any questions and/or notify you of the results of the Amazon gift card drawing.

 

Your Name(Required)

Two women wearing clear masks sit at a desk.

Questions

If you have additional questions, please click on the button below to send us an email.

Email Us with Questions