Tell Us Your KidSight Story

You can empower other parents to take action when they receive a KidSight referral – just by sharing your experience! Complete the story questionnaire below to get started.

  • Your Child's KidSight Screening

  • Your Contact Information

  • Accepted file types: jpg, png, pdf, Max. file size: 50 MB.
    You can also email photo(s) to
    The undersigned hereby irrevocably consents to and authorizes the use by KidSight, its officers and employees, of the undersigned’s image, voice, likeness and/or story as follows: KidSight shall have the right to photograph, publish, re-publish, adapt, exhibit, perform, reproduce, edit, modify, make derivative works, distribute, display or otherwise use or reuse the undersigned’s image, voice, likeness and/or story in connection with any product, service or program in all markets, media or technology now known or hereafter developed in KidSight’s products, services or program for the promotion of KidSight’s programs, as long as there is no intent to use the image, voice, likeness and/or story in a disparaging manner. KidSight may exercise any of these rights itself or through any successors, transferees, licensees, distributors or other parties, commercial or nonprofit. The undersigned acknowledges receipt of good and valuable consideration in exchange for this Release, which may simply be the opportunity to represent KidSight in its promotional and advertising materials as described above. The undersigned understands likenesses captured may be used as stated herein for an indefinite period.