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North Fort Myers Civic Association, Inc.

Parent Name *

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Address *

Address Line 1

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Email *

Phone

About your Child

Child's Name *

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Last

Age *

School Attending *

Grade *

Photography Minor (Child) Release -Type Legal Guardian Name *

By Submitting the Step Up for Shoes application, You are confirming you are the parent or legal guardian of the minor (child) in the application. You are granting your permission for the North Fort Myers Civic Association to use any/all photos & videos for any legal use including but not limited to: publicity, media, copyright purposes, illustration, advertising and web content.