• Your Contact Information

  • A Kid Again Child Information

  • Date Format: MM slash DD slash YYYY
  • Parent/Guardian Information

  • Parent/Guardian 2

  • Story

  • (Max 700 Characters)
  • (Max 700 Characters)
  • (Max 700 Characters)
  • Family Ambassador Opportunities

    Throughout the year, we share Family Ambassador stories via newsletters, blogs, social media, events, and more. Please, select the areas that you would be comfortable having your story shared or sharing your story.
  • Drop files here or
  • Media Release

    By submitting this form, I/we further authorize A Kid Again or any of its agents, directors, officers, servants, or employees to photograph, film and/or electronically record interviews with me/us in such a manner that they choose. I further authorize A Kid Again to distribute these recordings/films/pictures, now or at any time in the future to anyone including the general public, magazines, radio stations, TV stations, or newspapers or public relations, and/or news stories, or public presentations. In addition, by submitting this form I/we understand that multiple people have shared their stories with A Kid Again; therefore, the story I/we have submitted may not be used immediately.