Nm Story ReleaseNeighborhood Ministries Highlight Story Permission and Release FormStory Date Thank you for participating in Neighborhood Ministries (NM)! We would love to highlight you and your story to inspire, educate, and create change. NM is committed to sharing stories ethically, with dignity and respect for all participants. Please review and complete the form below.Participant InformationName(Required) First Last Phone(Required)Email(Required) Birthdate(Required)if under 18, parent/guardian must sign. Preferred Method of Contact(Required)Select OneTextPhoneEmailAgePERMISSION & RELEASEI,(Required)give my permission to Neighborhood Ministries (NM) to use my story, images, video, or audio recordings (hereafter referred to as “Story”) for development, outreach, and promotional purposes. I understand that NM may share my Story in the following ways:check all that apply: Website & Social Media Printed Materials (Newsletters, Brochures, Reports) Grant Proposals & Donor Communications Public Events & Presentations Video & Audio ProjectsEthical Storytelling CommitmentNM is committed to:Dignity & Respect: Representing your Story with integrity, avoiding sensationalism or exploitation.Informed Consent: Allowing you to review major edits or ask for Story removal whenfeasible.Privacy & Safety: Protecting personal details that may put you at risk.Confidentiality OptionIf you would prefer that your real name not be used in public materials, please check below: Please change my name in all published materials.Optional: Preferred pseudonym, if any:Rights & RevocationI understand that I can withdraw my permission at any time by contacting NM, and NM will cease using this specific Story in future materials. However, materials already published may not be retrievable.I understand that NM will not sell my Story or use it for commercial purposes.Acknowledgment & SignatureBy signing below, I confirm that:I have read and understood this form.I am giving this permission voluntarily.Participant Signature(Required)Your NameYour NameYour NameYour NameDate(Required) Parent/Guardian ConsentParent/Guardian Name(Required) First Last Parent/Guardian Signature(Required)Your NameYour NameYour NameYour NameDate(Required)
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