Recovery Story Submission

By filling out this digital release form, I (Name Listed in Form Submission) hereby grant Lifeline Connections permission to use my story in their printed and digital material, including their website & internet postings. I certify that this is not plagiarized from another source.

I understand that my recovery story I share with Lifeline Connections may be used in their publication in print or digitally as well as on their website and other social media and internet postings.

I understand that by completing this form I am allowing Lifeline Connections to use my story in their publications. At no time will Lifeline Connections assume rights to my story, other than by publishing it, and in subsequent electronic posts of pages from the publication on their website or social media. I also permit Lifeline Connections to make any necessary edits (i.e. grammar, spelling, etc.) to fit the publication as long as the integrity of the piece is not thereby compromised.

I understand that at no time shall I be paid, reimbursed or compensated, now or at any point in the future by Lifeline Connections.

I hereby hold harmless, release and forever discharge Lifeline Connections from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf or on the behalf of my estate have or may have by reason of this authorization.

I certify that I am at least 18 years of age.