I acknowledge that by submitting my survivor story to Break the Silence against Domestic Violence (BTSADV), I am granting them permission to use and publish my story online without regard to where it was previously published or quoted, such as news articles, personal social media and blog accounts, blog sites run by a third party curator, etc. I agree that BTSADV has complete ownership of this story, including the entire copyright, and may use the story for any purpose consistent with BTSADV’s mission.

I also give BTSADV permission to use my name*, likeness, image, voice, story and/or appearance as such in any pictures, photos, video recordings, audiotapes, digital images, publications, and the like, taken or made on behalf of BTSADV ​UNLESS​ I check the box “​I WISH TO REMAIN ANONYMOUS​,” on the website, in which case BTSADV only has permission to use and publish my story. I have read and understood this consent and release form.

*​Only first names are used in publishing survivor stories unless otherwise dictated by the survivor.