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Name*

First Last

Email*

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Address

State / Province / Region Country

Please let us know about where you live.

Date of Birth*

We ask for your birth date so that we can limit what is used on the website if you are under 18.

Date Diagnosed

If you don't know the exact day, don't worry. Just choose the correct month and/or correct year and note this in your story.

Your Story*

Please tell us about yourself and your connection to diabetes.

Your Photo

Accepted file types: jpg, jpeg, png, Max. file size: 25 MB.

If you have a photo, upload it here.

Short Bio

Please include a short bio of yourself so we can consider it for inclusion with the story. This will appear underneath your photo.

Consent to Use My Story and Photo*

I agree with terms below.

By submitting my information, photo, and/or video, I give Children with Diabetes permission to use my story, imagery, photograph(s), and/or video(s), in its promotional materials and publicity efforts. I understand that the imagery may be used in, but not limited to, a publication, print ad, direct-mail piece, electronic media, or other form or promotion; and that my name and additional information collected by the organization may be used in conjunction with the image(s). I release Children with Diabetes from liability for any violation of any personal or proprietary right I may have in connection with such use.

Cookie	Duration	Description
_ga	2 years	The _ga cookie, installed by Google Analytics, calculates visitor, session and campaign data and also keeps track of site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognize unique visitors.
_gat_gtag_UA_4658175_1	1 minute	Set by Google to distinguish users.
_gid	1 day	Installed by Google Analytics, _gid cookie stores information on how visitors use a website, while also creating an analytics report of the website's performance. Some of the data that are collected include the number of visitors, their source, and the pages they visit anonymously.
CONSENT	2 years	YouTube sets this cookie via embedded youtube-videos and registers anonymous statistical data.
uid	2 months	This is a Google UserID cookie that tracks users across various website segments.
vuid	2 years	Vimeo installs this cookie to collect tracking information by setting a unique ID to embed videos to the website.

Cookie	Duration	Description
NID	6 months	NID cookie, set by Google, is used for advertising purposes; to limit the number of times the user sees an ad, to mute unwanted ads, and to measure the effectiveness of ads.
OAID	1 year	Cookie set to record whether the user has opted out of the collection of information by the AdsWizz Service Cookies.
VISITOR_INFO1_LIVE	past	A cookie set by YouTube to measure bandwidth that determines whether the user gets the new or old player interface.
YSC	session	YSC cookie is set by Youtube and is used to track the views of embedded videos on Youtube pages.

Cookie	Duration	Description
C	1 month	No description
gpoll-timezone	session	No description available.
TPC	7 days	No description

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