Break the Silence - Community Action Partnership of Lancaster County

Are you a survivor of domestic violence, or the surviving family member of a victim, and want to share your personal story to help advocate for others?

Our team can work with you to help tell your story in a way that is safe and comfortable for you. If you prefer to share your story in a different format such as video or work with someone to tell your story, email marketing@caplanc.org

Name

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Share Your Story

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I authorize the use of the story to share with others(Required)

Yes

I wish to remain anonymous(Required)

Yes

Consent(Required)

The undersigned hereby authorizes the Community Action Partnership of Lancaster County, (CAP) and/or its officers, employees, representatives, affiliates, associates, agents and contractors to photograph and/or record graphic images of the undersigned. And hereby authorizes CAP to permit the use and display of such photographs and/or images in any print or electronic publication or presentation of CAP including display on the Internet site maintained by or on behalf of CAP. The undersigned hereby releases, holds harmless and forever discharges CAP, and its officers, employees, representatives, affiliates, associates, agents, and contractors from and against any and all claims, actions, demands, damages or liabilities of any kind or nature arising out of or in connection with the authorized use of said photographs and/or images, including but not limited to, any claims for invasion of privacy, defamation, compensation, royalty, or infringement of proprietary rights. The undersigned has read this release before signing below and fully understands its contents, meaning and effect.

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