Intake Form (Adult)
Complete the short form below, and don't hesitate to reach out if you have any questions.
Full Name
First Name
Last Name
Email
example@website.com
Phone
(000) 000-0000
Format: (000) 000-0000.
Location
City
Province
Birthdate
-
Month
-
Day
Year
Date Picker Icon
Height (cm)
Height in centimetres
If applicable: height while seated (cm)
Approximate height while seated in a wheelchair
Hair Colour
Eye Colour
If you have access to professional photos please upload them below. If not, please simply take and upload two images - preferably on a plain white background.
Image - Headshot
Browse Files
Drag and drop files here
Choose a file
Please upload a clear photo of your face from the shoulders up.
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of
Image - Full Portrait
Browse Files
Drag and drop files here
Choose a file
Please upload a clear photo of your full body. Be sure to include mobility and accessibility aids if applicable (wheelchair, walker, hearing aids, glasses, prosthetics, etc.)
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Disability & Accommodations
If applicable, please give a brief description of your disability or diagnosis, and/or any accommodation or access requirements.
Experience
If applicable, please describe any past modelling experience - including past or current agencies that you have been involved with.
Social Media
If applicable, please include any social media handles or links (Instagram, Facebook, etc.)
Comments
Add any additional information you think we should know about you!
How did you hear about Kello Inclusive?
Thank you! And please note - upon submitting, you should see a confirmation screen, however, we have heard that sometimes you may instead just see a blank screen. We hope to resolve this soon, but in the meantime, we do still receive the submission! We will follow up with you typically within a couple days after submission.
Submit
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