Please fill out the form below and sign the release form here.

  • Please Tell Us About Yourself

    To be filled out by a parent or guardian if you are a minor.
  • MM slash DD slash YYYY
  • Additional Family Members

  • B Kind Relief

  • Family/Individual Photo

    Please upload a photo for use on the B the Difference website.
  • Accepted file types: jpg, jpeg, png, gif.
  • Thank you!