Share Your Story

Your Name*
Your Child's Name*
Email Address*
Here is a little about my child and our experience with Kids Who Count.*
How have your child and family been impacted by the services you’ve received from Kids Who Count?*
What changes have you seen in your family and child as a result of services?*
Would you be willing to upload a photo of your child and/or your family?*
- Yes
- No
I agree to allow Kids Who Count to use my image and/or words in print, video, photographic, internet or other electronic mediums to advance the mission of Kids Who Count.*
- Yes
- No
Upload a Photo*
Max. file size: 2 GB.
Upload a Word Document (if applicable)
Max. file size: 2 GB.
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