Consent & Release Agreement

By sharing your experience, you are helping us eliminate addiction stigma and support the millions of Americans struggling with substance use. When contributing to our national story library, you are agreeing the following terms:

I, the undersigned, for myself or as the parent or legal guardian of the below-named minor child or other individual unable to give consent, grant to Shatterproof all right, title, and permission to create, use, edit/alter, copy, publish and display material containing my name, image, voice, words or likeness (“Material”) for any lawful purpose, and in any and all media including digital/internet/print use, without payment or any other consideration or credit to me.

I understand that these materials may be used in various applications that include but are not limited to: print media (newspaper, magazine, brochures), electronic media (video, audio) and online platforms (social media, email, website).

Any of these materials may be used in both edited and raw formats in their entirety or in part. Material includes:

  • Photographs and negatives
  • Reproductions and copies of original photographs
  • Drawings and artistic renderings
  • Audio, video, or multi-media recordings
  • Biographical material, written word/transcripts, or stories supplied by me or written about me

In addition, I waive any right to inspect or approve any finished product incorporating the above Material. This Consent and Release Form shall remain in effect unless and until revoked in writing sent to: Attn. Shatterproof Senior Director of Media and Public Relations, 101 Merritt 7, Norwalk, CT 06851.

I understand that if I revoke this consent, my revocation will not have any effect on actions already taken by Shatterproof in reliance on this consent. I further release, waive, and hold Shatterproof harmless from all claims, demands, and causes of action, including those related to publicity, copyright or moral rights, this I or my representatives, heirs, and assigns may have now or in the future.

By agreeing to these terms, I understand that I am giving permission for my information to be used for the purpose of promotion, fundraising and awareness as they relate to the organization’s mission. Additionally, I certify that I have read and understand this Consent and Release Form, am 18 years of age or older, have been given the opportunity to have my questions answered, and that Shatterproof will provide me with a copy of this consent upon my request.

Woman holding a bull horn

Together, We Can Change National Policy

Take action now to break stigma and expand access to recovery for millions of people. Your donation today will help us push for better policies on Capitol Hill.

Take Action