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Photo Shoot Participation Interest Form

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  2. Thanks for your interest in taking part in a photo session for Clay County Public Health! We are always looking for ways to share our services and impact with the community and photos of REAL people from REAL places in Clay County are one way we can do that.

    This form does not guarantee your participation in any particular photo session. After submitting this form, you may be contacted by a CCPHC staff member via email at any time. 

    At that time, they will extend a specific offer of participation and ensure your continued interest and availability. Communication information you provide may also be used to confirm your attendance closer to any session date.

    Participants will always be asked to sign a photo release form before any photos are taken. During photo sessions in 2026, community participants will receive a $20 gift card (one per household).

  6. Please list any names of people in your household that would also be interested in taking part. Briefly describe the group dynamic (parent/child, spouse, etc.).

  11. Interest Type*

  13. Describe the date, theme, etc. of the session you heard about.

  15. *Describe yourself - gender, race/ethnicity, age, etc. Also, do you have anything unique about yourself that you would be proud to show off or would represent a group that you're a part of? (Cultural or religious dress, assistive equipment, underrepresented body type, alternative style, etc.)

    *Nothing shared here would disqualify anyone from participation. It just helps us to know a little more about who might be taking part in any photo sessions we're holding. Ultimately, our goal is make sure that we fairly depict the people of Clay County.

    16. Leave This Blank:

  18. This field is not part of the form submission.