Media Release Form

Painted Brain would like to thank you for choosing to send your submission to submissions@paintedbrain.org. It is very important to us that individuals have the opportunity to express themselves in their chosen mediums and Painted Brain has provided a platform for individuals to do so. Painted Brain thanks you for being a part of our community and encourages you to continue to be involved. Please complete the following release form to have your work published with Painted Brain.
Date

MonthDayYear
Date
Name of Releasor*

First NameLast Name
Hereby authorizes Painted Brain to use the following items submitted (check all that apply):*

Video UseEmail blastsNewslettersBrochures or FlyersMagazinesWebsitesOther

Email of Releasor*
example@example.com
Phone Number of Releasor
Submission Terms & Conditions (1/2)

I acknowledge that by signing this document and providing this submission to Painted Brain, its use may include but is not limited to posting on social media, utilized for promotional materials and printed materials, and published on media.paintedbrain.org.

By signing this Agreement, I acknowledge that I was not forced or coerced to donate the aforementioned item(s). I do not expect or require compensation of any kind monetary or otherwise for this donation. I intend my relationship with Painted Brain to be considered that of a volunteer.

Covenant Not to Sue. To the extent permitted by law, I specifically agree not to commence any legal action against the Organization arising out of or in connection with this Agreement. To the extent permitted by law, I expressly agree that if I commence such an action in violation of this Agreement, I shall indemnify the Organization for the full and complete costs of defending such an action and enforcing this Agreement, including reasonable attorneys’ fees (whether incurred in a third-party action or in an action to enforce this Agreement), court costs, and other related expenses. By executing this Agreement, I am expressly waiving my ability to obtain relief of any kind from the Company to the extent permitted by law.

Submission Terms & Conditions (2/2)
- We will edit them for clarity, brevity, and style, post them on our site and share them with our news partners – they also may publish them.
- Essays, news stories, and personal stories must be between 2000 and 2500 words.
- Your commentaries must be exclusive to Painted Brain and up to about 800 words, although we may occasionally publish something longer or shorter.
- Please include your photo and email address for publication.
- If your piece is selected for publication, we will ask you to sign a release and a statement that you have read and accept our ethics policy.
- All submissions will be filtered through copyscape.com to prevent plagiarism.
- If there is a compelling reason, we will consider publishing anonymous commentaries. But this will be an exception, and we will need to be able to document who you are and understand your reason for requesting anonymity.
- If we do a substantial edit of a piece we wish to publish, we will give you the right to review it.
Submission Terms & Conditions*

I have read and agreed to the Submission Terms & Conditions
Attestation of Legal Age OR Attestation of Parent/Guardian*

I certify that I am of legal age and competent to contract in my own name. I have read this release before signing below and I fully understand the contents, terms, and the effect of this release.I am the parent or legal guardian of the named minor in this agreement. I have read this release before signing below, and I fully understand the contents, terms, and the effect of this release.
Signature of Releasor or Releasor's Guardian

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