Healthi Kids Kid-History | Spotlight Submission Form
A spotlight featuring talented Rochester-area kids who are actively exercising their abilities to be great.
Parent/Adult Full Name
*
Parent First Name
Parent Last Name
Parent/Adult Phone Number
Please enter a valid phone number.
Parent/Adult Email Address
example@example.com
Full Name of Kid or Teen You're Nominating
*
Kid First Name
Kid Last Name
My kid is a(n):
*
Entrepreneur
Athlete
Artist
Dancer
Singer
Actor
Scholar
Inspiration
Other
Tell us how amazing your kid is! How has your kid made tremendous progress? What success stories can you share? We encourage you to be as detailed as you like. Go!
My kid's favorite fruit is
blanks
field. My kid's favorite vegetable is
blank
.
What school does this kid attend?
Grade level:
Upload a photo of the kid you are nominating:
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Upload an additional photo or accomplishment for the kid you are nominating:
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Submission and Photo Release Agreement
By submitting this form, I confirm that I am the parent/guardian or have received permission from the parent/guardian to recognize the kid listed above. I acknowledge that this form grants permission for basic information and photos to be used for the Kid-History spotlight. I understand that this information may be featured on Healthi Kids communication channels as well as inside community newsletters, newspapers, television news, radio, social media, and other family-friendly communication channels.
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