Powered by WordPress

Username

User Form

Page slug

Warrior Profile Image

Warrior's Detail

Warrior's Name

Diagnosis

Date of Birth

Facebook Url

Twitter Url

About Your Warrior

Favorite Photo/Video of your Warrior

Video
Image

Profile Image

Profile Video

Tell Us Little Bit About Your Warrior

Does your warrior have a diagnosis? If not, type unknown.

Describe what your warrior has been challenged with

Want to show Video or Image

Video
Image

Describe what your warrior has been challenged with:

Provide any images that could help others understand what is happening:

Diagnosis Video

What has helped your warrior?

What has helped your warrior? Please upload/describe any alternative therapies or ideas that have seemed to benefit your warrior

	Title	Video Gallery	Description
1

Add Row

Additional Videos

Upload any additional videos that help paint the picture of what your warrior has gone through while on their journey

	Title	Video Gallery	Description
1

Add Row

Select Project

Our Projects

Here's how to help...

Donate Button External Url

Leave it blank and user will go to https://take-part.org/donate-now/ to donate
OR
If you have different donation URL then put in the below field. Please use URL with http:// or https://.

Enable/Disable Comments

Show Comment Form

Yes/No

Upload video to upload show everytime in sidebar

If there is a happy video of your warrior that you want visually available at all times on the website, please upload that here:

By Updating this information I confirm I am legally authorized to share this information and agree to Take Parts HIPPA and privacy agreement.

User Form Medical Details

Medical Records

	Title	Url or File	Link	File	Date of Treatment	Specialist
1		Url File		File name: File size:

Add Row

HIPPA release Policy *

By checking this box you agree to Take Part' HIPPA release Policy and understand that ALL files you upload will be openly available to anyone to see.

Registration confirmation will be emailed to you.

← Go to Take Part Foundation