skip to Main Content
Storytelling #1 - story anonymous

Your name with remain anonymous! It will not be shared with your story under any circumstance. We only need your name for the media release so that if you choose to revoke the use of your story we can identify which story it is.

Your phone and email are optional. We will only use this to contact you if we have a clarifying question.

Tell us your story!

We are honored that you are choosing to share your story. All of the fields below are optional. Please feel free to share however much you are comfortable with.

Media Consent

I hereby grant permission for Columbia River Mental Health Services (CRMHS) to share my story ANONYMOUSLY for the purpose of print and online advertising, social media, website, newsletters, presentations, events, blog, donor impact reports, e-mail, and other marketing and communication needs. I understand the story content may be edited or partially shared. 

I understand that I may revoke this consent at any time, but that the revocation cannot be backdated to stories that were previously shared by CRMHS. Resending my release, or choosing to not to release my information, will in no way impact your ability to receive appropriate services from CRMHS. 

I waive any right to royalties or other compensation arising or related to the use of my story.  By signing this release I understand this permission signifies that my story may be displayed via the Internet, print, or in the public setting. I waive the rights of my personal story without payment or any other consideration.

Back To Top