Participant Name
*
First Name
Last Name
Name of Legal guardian
*
Legal guardian must submit this form and grant image publication rights to Anthem Photography
First Name
Last Name
Guardian Email Address
*
Guardian Phone
*
(###)
###
####
Job or Volunteer Description
*
Please tell me more about your company/organization's role in the the community, as well as your personal contributions to the organization.
In what way(s) do you positivity contribute to our community?
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Your job, volunteer efforts, etc. - details are helpful!
Why do you choose to work/volunteer in this way?
*
How long have you worked in and/or served Blue Springs?
*
What are your favorite aspects of what you do?
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What are the most challenging aspects of what you do?
*
Do you have any statistics to share regarding the positive impact that your position or organization has on our community?
Ex: Number of citizens utilizing the service, amount of work performed per year, estimated social impact, etc.
What do you feel makes Blue Springs a great community?
*
Do you know someone who should also be featured in this project?
Please include full name(s) with contact info (if you have it), and a brief description of his or her community contributions. Or send him/her a link to this page to complete this questionnaire!
Photo release
*
To be featured in this project, a release granting Anthem Photography publication rights is required. By checking below, you acknowledge that you allow the photographer to upload images of the above named minor and responses to the questions above online, use on social media, and to use the images and responses in electronic and print media in perpetuity.
