Please read the Privacy Policy and Parental Notice before filling out this form.

Privacy Policy and Parental Notice Agreement *
Parent and/or guardian's name. *
Parent and/or guardian's name.
What is your child's name? *
What is your child's name?
(only the first name will be used in the illustration - see our 'Hero Gallery' for examples)
Eye and hair color can sometimes hard to determine from pictures alone. This is to make sure the final illustration is accurate to your child.
(flying, super strength, robot suit, etc)
(Super-Kevin, Lightning Girl, Tiger-Boy, etc)
(long green cape, black mask, purple gloves, golden belt, etc)
Do you wish to include a photograph of your child? If yes, it will need to be emailed separately from this form to *
Including a photograph of your child will help ensure that their likeness is accurately captured in the drawing.
Please include the following details: hair length, hair type (curly, straight, etc) skin color, height, and general build.
If your child is in a wheelchair, gait trainer or uses crutches, would you like those included in the superhero illustration? (optional)
Would you like your child's illustration to be included in our social media galleries (YATH Facebook page, Twitter, etc)? *
Would you like your child's image and story to be shared on our social media pages? *
This means we would share an image of your child (usually the one you've already provided along with this form) alongside their superhero while giving a brief description of their condition and their superhero's powers - only your child's first name will be displayed. For examples, head over to our Facebook page ( and under the "Photos" section check out the album titled "Hall of Heroes"
I give my consent to allow YATH to use my child's illustration in advertisements for 'You Are the Hero'. *
I consent that I am allowing 'You Are the Hero' to create an illustration using the likeness of my child. I understand that these images will be the sole property of 'You Are the Hero' and will not be sold to other outlets. *
YATH will maintain sole ownership of all images and illustrations, and will not sell them to third party companies under any circumstances.
Sometimes we receive cards and gifts for the kids at events from people who want to wish them well. This is in-case we ever receive any gifts for your child, so we know where to send them :)

Your privacy is guaranteed. None of the information provided here will be shared with or used by any other persons or organizations outside of 'You Are the Hero' unless otherwise notified and permission is received.