Media Submission & Release Waiver

In order to help spread awareness of Dravet syndrome, it is important for DSF to share the patient story through a variety of methods. This includes bringing a face to the disease through photos and videos on our website, social media, brochures and other promotional materials.

If you would be interested in sharing your child’s photo(s), video(s), and/or story with us, please complete the appropriate form(s) below.

Any questions on photo and video usage may be directed to wendy@dravetfoundation.org.

Photo/Media Release

To submit photos or video clips for use on our website, brochures, social media, and/or other promotional materials, please complete the submission form below and upload your hi-res photo files (in jpg or png format) or video clips (not to exceed 2MB). If you would prefer, you can email your photos and videos to wendy@dravetfoundation.org.

Media Submission

Submit photos and/or video clips
If you are interested in submitting your child’s photo(s0 or video(s) for use in DSF promotional materials, please check the appropriate box(es) below to begin the submission process.
- Photo(s)
- Video(s)
Name*
First Last
Email*
Child's Name*
Photos & Video Clips
Please upload photos in jpg or png format. Video clips should not exceed 2MB. Please try to include your child's last name as part of the file name (i.e., smith_photo_1.jpeg)
Drop files here or
Dravet Awareness Month Statement
If you are submitting a photo and statement for our Dravet Awareness Month campaign, please add your statement below. Statements should be 280 characters or less.
Signature*
I hereby grant permission to Dravet Syndrome Foundation (DSF) and its agents or employees to use my child’s photo(s) which I have submitted for publication in publications such as brochures and newsletters and to use said photo(s) on display boards and websites, without notifying me. I also acknowledge that DSF may choose not to use my photo(s) at this time, but may do so at its own discretion at a later date. I understand that once my image is posted on the DSF website, the image can be downloaded by any computer user. Therefore, I agree to indemnify and hold harmless DSF, its agents, volunteers, and employees from any claims. I agree to waive and release any and all claims against DSF and its contractors and licensees relating to my name, my likeness, the photo(s) and their uses and/or distribution in any version or media throughout the universe, including without limitation, any rights and claims relating to royalties or compensation, editing, alteration, copyright, distribution, misappropriation, libel, false light, rights of privacy and/or publicity. DSF reserves the right to discontinue use of photos without notice. To request that your child’s photo(s) be removed from the website and/or other materials, please submit a written request by email to wendy@dravetfoundation.org, or by fax at 203-907-1940. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.

Dravet Stories Submission Form

To include your child’s story on our website under Dravet Stories please complete the submission form below and upload your hi-res photo file(s). Photo will be cropped to 150×150 pixels. Please submit in jpg or png format. If you would prefer, you can email your story and photos to wendy@dravetfoundation.org.

You can read other Dravet Stories at this link.

Story Submission

DSF Website Story Submission

I would like to submit:
- My child's story & photo(s)
- Story only at this time
- Photo(s) only at this time
Name*
First Last
Email*
Child's Name*
Child/Adult's Story
Photos
If you would like additional photos of your child to be used in other marketing within DSF (website banners, brochures, etc), feel free to upload multiple pictures below. Thanks!
Drop files here or
Signature*
I hereby grant permission to Dravet Syndrome Foundation (DSF) and its agents or employees to use my child’s photo(s) which I have submitted for publication in publications such as brochures and newsletters and to use said photo(s) on display boards and websites, without notifying me. I also acknowledge that DSF may choose not to use my photo(s) at this time, but may do so at its own discretion at a later date. I understand that once my image is posted on the DSF website, the image can be downloaded by any computer user. Therefore, I agree to indemnify and hold harmless DSF, its agents, volunteers, and employees from any claims. I agree to waive and release any and all claims against DSF and its contractors and licensees relating to my name, my likeness, the photo(s) and their uses and/or distribution in any version or media throughout the universe, including without limitation, any rights and claims relating to royalties or compensation, editing, alteration, copyright, distribution, misappropriation, libel, false light, rights of privacy and/or publicity. DSF reserves the right to discontinue use of photos without notice. To request that your child’s photo(s) be removed from the website and/or other materials, please submit a written request by email to wendy@dravetfoundation.org, or by fax at 203-907-1940. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.