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Expressive Arts and Writing Release Form

In the interest of promoting the education and training of Focusing-Oriented Expressive Arts (FOAT®), expressive arts therapies, and Focusing, I grant Laury Rappaport, Ph.D., LMFT, REAT, ATR-BC and the Focusing and Expressive Arts Institute, the right to reproduce my media (writings, artworks, recording, and other audio-visual materials) for the following uses identified below.  I have had the opportunity to ask questions about the potential uses of my media.  I also understand that I can consent to some or all parts of this release form.

I agree to allow Laury Rappaport and the Focusing and Expressive Arts Institute to use the following:

Check all boxes that apply to the media that you agree to be shared

Expressive Arts and Writing Permission  

I give Dr. Laury Rappaport and the Focusing and Expressive Arts Institute permission to use my media for the following purposes:

Please check all that apply

Anonymity or Name Option

Please select one

I hereby grant the use of my media 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 work 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.

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Today's Date (MM/DD/YYY): *

(Optional) Contact information

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Your Expressive Arts and Writing Release Form has been successfully submitted. Thank you for your contribution to our community!

Please email us at office@focusingarts.com if you have any questions.

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