Share Your Story

Have you participated in Dream It, Be It? Did you have a great experience? Has it helped you pursue your education and career goals? Tell us about it!

Of course, if you are under 18, we still need your parent/guardian’s permission to talk to you or to publish your picture and story! If you are 18 or older, we just need your permission.

Completing this form is optional, and you can choose how much information you wish to disclose. 

If you want to save your progress and continue later, use the "Save" button at the bottom. You will receive an email with a link to resume your form.

We use these collected stories and testimonials to share the program’s impact, motivate our volunteers, and attract donors so that we can continue offering Dream It, Be It to more girls who would benefit from the experience. Thank you.

Signing this Media Consent Form is voluntary. We respect your choice and will not use your or your child’s information without your permission.

By signing this Media Consent Form, you give Soroptimist & LiveYourDream.org, permission to take photographs and make videotapes and voice recordings of the below-mentioned girl (the “Presenter”) and grant Soroptimist & LiveYourDream.org the unlimited and perpetual right to reproduce, display, communicate, perform, distribute, publish, circulate, make derivative works, or otherwise use the Presenter’s name, biographical details, first hand story, testimonials, quotes, city and state or province of residence, likeness, photograph, audiovisual recordings, image and/or voice (the “Works”) in whole or in part, for publicity purposes, fundraising appeals, advertisements and otherwise in connection with the mission of Soroptimist & LiveYourDream.org, in various formats including, but not limited to, print, photographs, video recordings, and audio recordings in any and all media including but not limited to print media, social media, websites, television, audiovisual and electronic media. All such Works shall be the property of Soroptimist & LiveYourDream.org which shall own all right, title and interest.

You hereby waive, and waive on behalf of the Presenter, all rights of publicity and privacy which you and the Presenter may have in the Works and any right or option to inspect or approve the finished product or advertising or other copy that may be used along with the Works. You hereby waive and release, and waive and release on behalf of the Presenter, any claims you and the Presenter now have or in the future may have against Soroptimist & LiveYourDream.org (and the other releases mentioned below) relating to or arising out of the use of the Works including, without limitation, any claims for compensation for the use of such materials.

Without limiting the above, you consent and provide consent on behalf of the Presenter to SIA’s use and disclosure of the Presenter’s personal information contained in the Works or otherwise provided by the Presenter to SIA (“Personal Information”), including sensitive Personal Information, for the purposes outlined above. You understand that:

• SIA may use and disclose the Personal Information, including the Presenter’s personal story, testimonials, and information on her life experiences, for promotional purposes on the Internet, in the media or otherwise.
• It is possible that the Presenter could be recognized by persons who know her, based on her image, voice, testimonials and/or the description of her story/life experiences.
• Information disclosed by SIA will be available to the public and may be used and re-disclosed by any recipient or other third party. It is possible that an unknown third party may try to use the Personal Information to exploit the Presenter. SIA is not able to control the use or disclosure of the Presenter’s Personal Information by such third parties.
• The Presenter’s Personal Information will be stored in Philadelphia, PA and accessible to the staff of SIA, who have a need to know such information to perform their job duties. The Personal Information will be transmitted, stored and published in countries other than Canada, including but not limited to the United States, for the purposes outlined above. Information transferred to other countries may be accessed by the courts, law enforcement and national security authorities in the jurisdiction(s) where it is transferred, processed or stored.

You or the Presenter may withdraw consent to SIA’s continued use and disclosure of the Presenter’s Personal Information at any time. However, please note that such withdrawal will not have retroactive effect, and SIA cannot control continued or further distribution of Personal Information by third parties, to the extent that such Personal Information has already been published or otherwise made available to persons outside SIA’s control. You or the Presenter may contact program@soroptimist.org or 215-893-9000 to withdraw consent, or to access, correct or update Personal Information, as well as to obtain written information or make enquiries about SIA’s privacy policies and practices including use of service providers (including affiliates) outside the United States and Canada.

This consent and release shall be applicable to Soroptimist & LiveYourDream.org, its subsidiary or affiliated companies, their officers and directors and other agents or employees who may be involved in disseminating the Works, and to the photographer, the videographer, the advertising agency or publisher of any material in which the Works may be used. You also understand that any use, including the broadcast and publication, of the Works is within the sole discretion of Soroptimist & LiveYourDream.org and that they may not be used at all.

The undersigned represents that he/she is a parent or guardian of the above named minor, that he/she has the legal right to consent to the terms of this Media Consent, that he/she has read the foregoing instrument and that he/she for an on behalf of the said minor, and in his/her own capacity, consents to, accept and approves this Media Consent and releases Soroptimist & LiveYourDream.org, and the other persons to whom the release is applicable, from any claim or liability with respect to the said creation, use and dissemination of the Works as set out herein.

Next, we have some additional questions that we'd like to ask to learn more about you and your Dream It, Be It experience. If you would like to complete this section, it will take approximately 15 minutes of your time.

Your story will help us share about the power and potential of Dream It, Be It to future participants and supporters of the program. Thank you for sharing.

Answers can be submitted in typed form or via video (videos are especially appreciated by our supporters). 

If you want to save your progress and continue later, use the "Save" button at the bottom. You will receive an email with a link to resume your form.