Thank you for your willingness to share your story. This form ensures your comfort, safety, and consent are respected throughout the storytelling process. You can choose how much you want to share, how you want it shared, and whether your name is included. You can withdraw your consent at any time, no explanation needed.

This form can be filled out virtually (via email, voice note, or secure web form) or in person with a trusted collaborator organization. Completed forms can be emailed to carewithoutcoercion@catalysthaven.ca by the collaborator or directly by the storyteller.

Download Consent Form

Name *

However you wish to be identified

First Name

Last Name

Email or Phone Number *

However you wish to be contacted

Story Submission Type *

Check all that apply

Written Story

Audio Clip

Video Story

Quote (short except or statment)

I don't know yet - I would like some help shaping or writing my story

Anonymity & Attribution *

Choose one that feels right to you

How Can We Share Your Story? *

Check all that you're comfortable with

Social media (Instagram, Facebook, X, Bluesky)

Blog post on campaign website

Short quote or excerpt used in a graphic or post

Video or audio clip (with or without your name/face)

Press/media outreach (with explicit confirmation before use)

Campaign presentations or public education events

Consent and Acknowledgement

I understand that I can withdraw my story or revoke my consent at any time by contacting the campaign team. *

Yes

I understand that minor edits for clarity or format may be made, and I will be consulted before any major changes. *

Yes

I understand my story will not be sold, monetized, or used outside this campaign. *

Yes

I understand that I have the option to connect with a support person, through the Care Without Coercion Campaign if needed. *

Yes

Thank you!

Stay Connected

Email Address

Thank you!

With humility and gratitude, we acknowledge our work takes place on sovereign Indigenous lands and traditional territories across Turtle Island. We acknowledge that the land are on is, always has been, and will always be the home of Indigenous Peoples.

We live, work and play on the traditional territories of the Siksika, Kainai, Piikani, Tsuut’ina, Îyârhe Nakoda, Nehiyaw, Dëne Sųłiné, Dane-zaa, Nakota Sioux, as well as the Métis Peoples of Region 1, 2, 3, 4, 5, and 6 and all people who make their homes in Alberta. These lands are subject to Treaties 4, 6, 7, 8, and 10, and have long served as meeting grounds, travel routes, and gathering places for many diverse First Nations as well as Métis, and Inuit peoples. We recognize all these Nations and communities, whose rich histories, languages, cultures, and traditions continue to thrive and are key to the enrichment of all our communities.

We are grateful for the traditional Knowledge Keepers and Elders who are still with us today and those who have gone before us. We make this acknowledgement as an act of reconciliation and gratitude to those whose territory we reside on.