BOC Members: What Do You Aspire To?

To "aspire" means to direct your hopes or ambitions toward achieving something. We are asking Beads of Courage members to share what you aspire to! This could be something short-term or long-term ... perhaps a treatment-related goal, what you want to learn more about, a skill you aspire to, or what you want to be when you grow up. Use your imagination!

To complete your submission, please tell us what you aspire to by providing a written quote and a photo of the BOC member with their beads OR a video of the BOC member answering the question. The best photos are high-resolution with nothing distracting in the background. If you submit a video, please make sure we can hear what is being said.

If you have any questions, please email becca@beadsofcourage.org. Thank you for your help!
Name of Parent or Legal Guardian completing this form Name of Parent or Legal Guardian completing this form First Last
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
BOC Member's Name BOC Member's Name First Last
BOC Member's Date of Birth BOC Member's Date of Birth / MM / DD YYYY
Which program does the BOC member participate in?

Which program does the BOC member participate in? Hematology/Oncologly Cardiac Chronic Conditions NICU Other Other
Where does the BOC member receive their beads? Please enter the name of the hospital/clinic or Beads in the Mail.
OPTIONAL: What medical conditions does the BOC member receive beads for?
PHOTO OR VIDEO INSTRUCTIONS: If you are uploading photos, please answer the "aspire" question in writing below. If you are uploading a video, please answer the question in the video.
Please complete this in the BOC member's own words if possible (if not, that's okay): I aspire to ____________________________________________________________________________.
Please upload 1-5 photos or a video as described above.

Attach Files
Were the photos taken by a commercial photographer?

Were the photos taken by a commercial photographer? Yes No N/A
I hereby give Beads of Courage, Inc. permission to use the photo(s) or video and content I have provided, in perpetuity, for any purpose deemed appropriate by Beads of Courage, Inc., including but not limited to: print materials; newsletters; signage; on the Beads of Courage website and social media accounts; for media coverage (television, blogs, newspaper, magazine, ezine, ebook, etc.); for educational purposes; for publicity benefiting Beads of Courage, Inc.

I hereby give Beads of Courage, Inc. permission to use the photo(s) or video and content I have provided, in perpetuity, for any purpose deemed appropriate by Beads of Courage, Inc., including but not limited to: print materials; newsletters; signage; on the Beads of Courage website and social media accounts; for media coverage (television, blogs, newspaper, magazine, ezine, ebook, etc.); for educational purposes; for publicity benefiting Beads of Courage, Inc. Yes No
Date of Photo/Video Release Date of Photo/Video Release / MM / DD YYYY
ELECTRONIC SIGNATURE: By placing your signature in the box below, you are hereby waiving any right of compensation or ownership thereto.
THANK YOU FOR SHARING YOUR PHOTOS, VIDEOS, AND STORIES WITH US!

BOC Members: What Do You Aspire To?

BOC Members: What Do You Aspire To?

PHOTO OR VIDEO INSTRUCTIONS: If you are uploading photos, please answer the "aspire" question in writing below. If you are uploading a video, please answer the question in the video.

THANK YOU FOR SHARING YOUR PHOTOS, VIDEOS, AND STORIES WITH US!