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What's Your Story

  1. Complete this Statement
  2. CONSENT: By participating in this “What’s Your Story?” awareness campaign, I, or my representative (guardian, parent, advocate), give permission for my photo to appear in FCBDD public awareness. Only my “picture” and “story,” will be used. My name will not be used with my photo. My name and contact information are for FCBDD verification purposes only. I understand that if my photo is posted to FCBDD’s facebook page, it is no longer protected by privacy rules and may be copied or forwarded by people who visit Facebook. I may withdraw my consent to include my photo in this awareness campaign at any time by submitting my request to My consent will not expire unless I submit a request to withdraw it.
  3. I agree to these terms and conditions*

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  5. This field is not part of the form submission.