4C Faces of Impact Consent Form

4C Faces of Impact

Child Photo, Story & Donor Recognition Consent Form

Our donors and sponsors love seeing the children and families their gifts help. This form lets you choose exactly what, if anything, 4C Sensory Center may share about your child.

💚 Your choice, always

Giving permission is completely voluntary. Saying no, or choosing only some options, will never affect your family's ability to receive items, services, or support from 4C.

You can change or withdraw your permission at any time. We will never share your child's last name, home address, or school.

Parent or guardian full name *

Email *

Phone number

Your relationship to the child *

Child's first name (list each child this form covers) *

What may 4C share? Check only what you are comfortable with. *

Each choice is separate. Leave a box unchecked if you do not want that shared.

Photo for donors and sponsors. Share my child's photograph privately with donors and sponsors. First name. Share my child's first name along with any photo or story I allow. Our story. Share a brief story about my child's needs or how 4C has supported our family. Thank-you letters and reports. Feature my child in donor thank-you letters, sponsorship presentations, and impact reports. Website and social media (public). Share my child's photos on the 4C website and 4C social media pages. This is separate from the donor-only choice above. Anonymous only. Keep my child's identity private (no photo and no name), but 4C may share our story anonymously. No sharing. I do not give permission to share any photos, names, or stories about my child.

Please check at least one box, or choose "No sharing."

Anything you want us to know, or anything we should never share?

Type your full name as your signature *

Today's date *

I am this child's parent or legal guardian. I understand this permission is voluntary and that I can change or withdraw it at any time. *

Your form goes straight to the 4C Sensory Center team at founder@4csensorycenter.org and is kept private.

How to Change or Withdraw Permission

You can change your choices or withdraw your permission at any time. Email founder@4csensorycenter.org with the subject "Withdraw or Change Consent" and your child's first name.

Once we receive your request, we will stop using your child's photo, name, or story in anything new.
We will remove your child's photos and story from the 4C website and 4C social media pages.
Materials that were already printed, mailed, or presented before your request (such as letters or reports) cannot be taken back, but they will not be used again.

Your permission stays in place until you change or withdraw it.

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