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Please complete this form to submit your story or specific content to Autism Ontario, including photographs, videos, stories, artwork, written works, testimonials, or articles, and provide consent for use of such content.

Note: If you are submitting an article for Autism Matters Magazine, we encourage you to submit a photo to accompany your work.

1. What type of content would you like to share?

Media (photography, video)

Art work

Autism Matters Magazine article

Testimonial

Impact story

Media consent for an event/program

Name and Date of Event/Program Attended

2. Individual name:

3. Individual email address:

4. Consent, Waiver, and Release

I hereby grant permission to Autism Ontario to reproduce, use, exhibit, display, broadcast, and distribute this submitted content for use in connection with supporting Autism Ontario’s mission, vision, and values, programming initiatives, and marketing/communications or for promoting/publicizing the organization’s activities. This permission includes, without limitation, the right to publish this content on Autism Ontario’s website, in reports and publications, promotional materials (e.g., marketing, advertisements, fundraising materials), and/or other Autism Ontario-related publications. I consent to the use of this content, together with names and any illustrations, depicting myself, my immediate family and/or friends for general release to the public. This content may appear in any of the wide variety of formats and media available now or that may be available in the future, including but not limited to print, broadcast, and electronic/online media. I understand that there will be no compensation to me for the use of the work(s) and/or photography/video. I waive any claim against Autism Ontario and staff, for any personal or emotional distress that may arise in connection with the use of the work(s) and/or photography/video.

I confirm that I, as a person on the autism spectrum OR a parent/caregiver OR family member of a person on the autism spectrum, have read and fully understand the contents, meaning, and impact of this consent, waiver, and release form. I confirm that I have received permission to submit this content.

I hereby waive, grant, and release to Autism Ontario the right to publish my name and content and/or the name(s) and content of my legal minor child (under 14 years of age).

Autism Ontario has my consent and authorization to use this content as described above. Note: All content can be removed from our website at any time upon request, though we cannot guarantee that works circulating beyond our website will be removed. Consent is valid until named individual(s), or parent, indicates otherwise in writing to Autism Ontario. If you have any questions or concerns, please connect with us at submissions@autismontario.com.

5. I consent that the content I am submitting may be: (Select all uses you consent to):

Printed in materials such as Autism Matters Magazine, annual reports, fundraising communications, etc.

Placed on Autism Ontario website(s)

Posted on social media channels affiliated with Autism Ontario, including Facebook/Twitter/Instagram/YouTube/LinkedIn or others

Incorporated into Autism Ontario's promotional materials such as brochures, videos, and campaigns

Used in material by any authorized program(s) of Autism Ontario

6. Name of individual:

7. Individual's age:

8. City of residence of individual:

9. How should the individual's name be displayed? (Check each item you consent to)

First name

Last name

Last initial

Age

City

10. I am a:

Self-advocate

Parent/caregiver/family member of an autistic person

Donor

Beneficiary

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Program participant

11. How have the programs at Autism Ontario changed your life? If you had the opportunity, what would you say to the donor who enabled your participation in one of our programs?

12. Why do you believe it's important to donate to Autism Ontario?

13. File Upload

Upload your file here

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30 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, odf, pdf, doc, docx, ppt, pptx, avi, mov, wav.

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