Family Leadership Vision Success Videos: Interest Form

Family Leadership Vision Success Videos: Interest Form

We are creating a series of short videos of Alumni highlighting real stories of family vision and success, and we'd love to feature yours. These videos will be shared on our program website, social media, and more to uplift and connect families across our community. Families who are selected, will receive recording support from Erin Bose and a small stipend. Please reach out to Maryann, at mawelch@riversidecc.org, if you have any questions.
Name*

First NameLast Name
Email*
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Phone Number
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What Massachusetts DDS region do you live in? (Find your region at https://www.familyleadershipma.org/family-leadership-series/dds-regions)*
Are you a graduate of the Family Leadership Series (FLS)*

No.I am currently attending the FLS in my region.Yes, I am a graduate!
Please briefly tell us what you’d like to share—a story that reflects your disability-related vision and a success that could inspire other families. Examples might include: A moment when your family member achieved a personal goal; A time when your vision helped guide a big decision or transition; An example of meaningful inclusion in school, work, or community; How your family worked together to overcome a challenge; How providers, supports, or services helped your loved one thrive. Your story can be simple or significant—what matters most is that it offers hope, possibility, and inspiration to others.
Media Release

Family Leadership Program
I willingly consent to be identified by name and have my picture, video, story, or voice (collectively “my media”) used without restriction by Family Leadership Program to positively promote or communicate The Family Leaderships Program's services and programs to staff, donors, and the general public or empower other families.

I understand and agree that:

My media may be used, re-used, published, or re-published, in whole or in part, without restriction, in any form including but not limited to social media, online, print, on TV, audio recording, broadcast, and streaming services, videos, publications and on Riverside’s organizational and program websites for current or future marketing purposes.

I release the Family Leadership Program its personnel, and any other persons handling my media from any liability connected with the use of my media, including any claims for libel or invasion of privacy. I will not disclose the identity of other people served.

I may revoke this authorization in writing at any time, except to the extent that action has already been taken in reliance on it.

This release shall be governed and interpreted under the laws of the Commonwealth of Massachusetts.
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Family Leadership Vision Success Videos: Interest Form

Media Release