We’d love for you to share your story and hear how the Y has positively impacted your life.

Have you improved your health and developed new strengths? Has a Youth Sports coach helped your child learn new skills, build confidence, and develop healthy habits? Did a Y personal trainer help you prepare for a marathon or another physical fitness competition? Has your family benefited from our financial assistance program? Has your child learned life-saving water safety skills through Y drowning prevention lessons or swim lessons? Have you created a healthy routine that works for you?

Please fill out this form to share your story with us!

Photo/Audio Visual/Narrative Release


I am 18 years of age or older. If not, my parent or legal guardian must consent and give permission on my behalf. 


For participation in activities to be conducted by the YMCA of Central Florida, consent must be provided, now and indefinitely, to the YMCA of Central Florida and collaborating third parties to make, reproduce, edit, broadcast or rebroadcast:
  • video film or footage of me (or my dependent child),
  • sound track recordings of me (or my dependent child),
  • photo reproductions of me (or my dependent child),
  • any narrative account of my (or my dependent child’s) experience.

Consent gives permission to use the above materials for publication, display, sale or exhibition in promotions, advertising, education and legitimate business uses. Use includes unlimited and unrestricted reproductions in any form and media, adaptations and/or revisions created for YMCA of Central Florida use.

I understand and agree there may be no compensation for this, and I will not make any claim for payment of any kind. I may, or may not be, identified in such reproductions; however, my name will not be used to endorse any particular commercial products or commercial services.

Ownership, Confidentiality, and Shared Use

With respect to any of the above uses, I further agree:
  • All uses shall belong to the YMCA of Central Florida and it may share them with others;
  • There is no obligation of confidentiality
  • YMCA of Central Florida and collaborating third parties will not be liable for any use or disclosure to a third party
  • YMCA of Central Florida shall exclusively own all known or later existing rights to the uses worldwide.
  • YMCA of Central Florida can use any video film, footage, sound track recordings and photo reproductions of me and/or my narrative account for any purpose and without compensation to me.

Release from Liability 

I agree that my consent is irrevocable. I hereby release and discharge the YMCA of Central Florida, its related parties and those it has given permission to use the above, from any and all claims, actions, lawsuits or demands of any kind arising out of my consent, the use or the shared use of the above materials.