Sign Form

1
Your Name* This field is required.
First Name
Last Name
2
Are you 18 or older?* This field is required.Only those 18 or older may complete this form.
YESNO
3
Today's Date* This field is required.
Date
Year
Month
Day
4
Who are you filling this form out for?* This field is required.
Myself
My Child
My Ward
5
Your Child or Ward's Name* This field is required.
First Name
Last Name
6
Parent or Guardian Confirmation* This field is required.
7
Mailing AddressOptional. WARM may send a thank you card in the mail for sharing your story.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Phone Number* This field is required.We may call you if we need additional information.
Area Code
Phone Number
9
Email* This field is required.We will send you a copy of your form submission via email.
example@example.com
10
WARM needs a clear photo of your face to keep with your release form. Do you want to take a new photo or upload one from your device?* This field is required.
Take a Photo
Upload From My Device
11
Take Photo* This field is required.
12
Upload Your Photo* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
13
If there are things you do not want your materials used for, list those here.
14
Terms and Conditions* This field is required.I grant WARM permission to make photographs or video of such minor and/or myself; I grant WARM permission to use or sell to others the finished photographs or video containing the image or likeness of such minor and/or myself for any publication(s) WARM deems to be proper, subject only to any express conditions set forth in this release form. In my own behalf, and on behalf of such minor, I relinquish and grant WARM any and all right, title and interest that the minor or I may have to such photographs or video and to income that might be derived from such photographs/video or publications which may include YouTube for purposes of linking to their website. WARM, its agents, employees, successors and assignees are released and forever discharged from liability to me, my child(ren) or ward(s) named below, and our heirs, successors or assignees, for any claims, expenses, losses, liabilities, damages, or causes of action of any nature resulting from WARM’s authorized use of such photographs or video in any publication which may include YouTube for purposes of linking to their website.
15
Signature
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