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Arts Expression Release Form

This agreement will grant Laury Rappaport. Ph.D., LMFT, REAT, ATR-BC and the Focusing and Expressive Arts Institute the right to reproduce your arts expression and associated information you provide with the conditions below.

Name of exercise that corresponds to your Arts Expression: *

Please submit your artwork/writing using the upload button below that match the media file type: *

If you have any trouble with uploading your materials, please email them to


I agree to allow Laury Rappaport and the Focusing and Expressive Arts Institute to use my arts expression for the following purpose(s):

Please check all that apply.

Anonymity preference:

Please select one:


Description of your Arts Expression

A word, phrase, sentence, or more that describes something important to you about the FOAT experience/Arts Expression.

Title of your Arts Expression:

I hereby grant the use of my arts expression and associated information as defined by the purposes above to Laury Rappaport and the Focusing and Expressive Arts Institute in perpetuity.  I give express consent to the altering or editing of the aforementioned work for editorial purposes and waive the right to inspection or approval of the finished product.  I attest that I have voluntarily provided my artwork in accordance with the agreed upon conditions in this release form.  I acknowledge that once I sign and submit this form, I will have three (3) days to withdraw my consent.

Enter your full name: *

Email Address: *

Electronic Signature: *

Once you press the Submit button, please wait for the system to process your input. If you uploaded a video, this process may take up to a few minutes. Please keep this browser tab open until you see the success message below:

Your Arts Expression Release Form has been successfully submitted.

Thank you for your contribution to our community! You may close this window at any time.

For questions, please email

An error occurred. Please check to make sure all required sections are filled out and try submitting the form again. If you need further help, please contact us for assistance.

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