Cincy Senior Stories

Online Submission Form

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Fill in Form

Step 2

Upload Photo

Step 3

Sign Form

Online Submission Form

These questions should ideally be answered by your Cincy Senior to help share their story, but if Alzheimer’s has limited the ability to do this, please feel free to answer with their story and voice in mind. Not all questions are required. Write as much or as little as you like and we may edit for length but will not alter content.

Name of Individual *

First

Last

Name Submitting Photo (Your Name) *

First

Last

Email *

Phone *

Attach Your Photo *

Click or drag files to this area to upload. You can upload up to 3 files.

Attach the photo(s) that you'd like us to use for the entry. This photo should include the face of your loved one, ideally without others in the picture.

What was the happiest moment of your life?

Who has been most influential in your life?

What advice or quote did you always try to live by?

What is one memory from your past you cherish?

Any regrets or advice you’d give to a younger you?

Anything else you wish to share?

Signature *

Clear Signature

The Giving Voice Foundation PHOTO RELEASE FORM. I hereby grant The Giving Voice Foundation permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of The Giving Voice Foundation and will not be returned. I hereby irrevocably authorize The Giving Voice Foundation to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge the Giving Voice Foundation from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. In Signing Here I ACCEPT the terms of this agreement.

Hear Their Voices

Daphne R

by givingvoice | Aug 31, 2020 | Cincy Senior Stories

I guess maybe when I had my first child. It was really representative of a very big change in my life but I’ve had so many. Graduating from high school, graduating from college, getting my first job. I guess I should include getting married too.

Dale H

by givingvoice | Aug 13, 2020 | Cincy Senior Stories

Hope it hasn’t happened yet. However, I have lived a happy and charmed life; When I married the most beautiful girl I could ever imagine; When I passed my State board exams to become an Architect; when I was on 2 national NCAA basketball championship teams for University of Cincinnati (1961,62); The births of my 3 wonderful children and 6 wonderful grandchildren;
And lastly I am in good health at 79 years old.