Share Your T1D Story
Tell us about your connection to T1D and how you’d like to get involved in the 145K for T1D community filming and fundraiser.
About you
Full name
*
First Name
Last Name
Email
*
example@example.com
Mobile / phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your connection to T1D
*
I live with T1D
My child lives with T1D
Another family member lives with T1D
Friend or carer
Other
If other, please specify
Membership status
Yes
No
Used to be
Usual gym
Keswick
Kent Town
Thebarton
None yet
Getting involved
How would you like to be involved?
*
Speak on camera for a reel
Be filmed climbing (no speaking)
Share a written quote or story
Attend the Saturday community day (14 Nov, Thebarton)
Volunteer on the day
Not sure yet, keen to chat
T1D story
Anything you’d prefer not to be mentioned or shown
Availability for filming
Weekday mornings
Weekday afternoons
Weekday evenings
Weekends
Preferred location for filming
Keswick
Kent Town
Thebarton
Flexible
Under 18s
Is the person taking part under 18?
*
Yes
No
Participant’s name and age
Parent or guardian full name
First Name
Last Name
Consent
Consent to filming, photographing, and use of my image and story for social media, website, and promotional materials for the 145K for T1D fundraiser
*
I consent
May your first name be used?
*
Yes
No
I understand that consent can be withdrawn at any time by contacting Beyond Bouldering
*
I understand
E-signature
*
Submit
Submit
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