Submit Your Story for Inclusion in the Words Matter Campaign

by

If you have questions or have any issues filling in the form email us at info@harmony.ca or call 416-669-2051 for support.

When sharing your story, we ask that you avoid using harmful language directly. If you’re recounting an experience where harmful words were spoken, feel free to describe the situation without quoting the actual words. For example you can say they used a racial slur or a made a homophobic comment. This will help us have these conversations in ways that are safer and respectful for those who hear your stories. 

Your Details

Name
Age:
Note for those under 18 unless there are special circumstances we require parent or guardian consent. If you are under 18 and filling in this form, do so with the assistance of a caregiver.

Media Consent Form for Participation in the Words Matter Campaign

By signing this form, you are granting permission to Harmony Movement to voluntarily participate in the Words Matter Campaign. This includes:

  1. Uploading Your Story:
    You may share your personal story or experiences about the impact of harmful or discriminatory language in school spaces through your chosen medium.
  2. Usage of Media:
    The submitted materials may be shared in:

    • Educational presentations in schools.
    • Digital platforms, including social media, websites, and campaign materials.
    • Public awareness efforts to promote respectful and inclusive school cultures.

Confidentiality:
While your story may be shared publicly, we respect your right to confidentiality. Please indicate if you consent to your name being included, or if you prefer your story to remain anonymous:

I consent to the following details being shared with my story:
Please select your preferences of what can be shared with your story, and what aspects you prefer not shared. Check the last box if you are ok to share your story with no additional identifying details.

Right to Withdraw:
Participation is completely voluntary, and you may withdraw from the campaign at any time without penalty. If you withdraw consent, all media featuring you will be removed from future use.

Duration of Consent:
This consent is valid for the duration of the Words Matter Campaign. If you wish to revoke consent at any time, please contact the campaign coordinators at info@harmony.ca.

Share your story!

If you do not want to upload a video, but want to share more details about a story via text you can include them here or attach a word file.
Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.