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Arts and Writing Release Form for Training Documentations

This agreement will grant Laury Rappaport, Ph.D., LMFT, REAT, ATR-BC and the Focusing and Expressive Arts Institute the right to reproduce arts expressions and writing from submitted documentation assignments during FOAT® Training for the purpose(s) below.

I agree to allow Laury Rappaport and the Focusing and Expressive Arts Institute to use my arts expressions and writing from the following FOAT® Trainings:

Please check all that apply. Required

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

Please check all that apply. Required

Anonymity preference:

Please select one:

I hereby grant the use of my arts expression and writing 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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Note: The information you submit on this form is protected and will be kept only for the Focusing and Expressive Arts Institute's private records.  The name that will accompany your work will follow your preference and anonymity choice established in the form above.

Enter your full name: *

Email address: *

Electronic Signature: *

Today's Date:

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