Media & Testimonial Permission Form

At times, moments from a retreat, coaching session, mastermind call, or other program with me may be helpful for others to see or hear. These can include insights, coaching conversations, demonstrations of The Work or the Wheel of Self-Forgiveness, personal reflections, celebrations, as well as the wonderful comments and testimonials you've shared about your experiences and results.

Members of my team and I would be grateful if you could take a moment to review the material shared with you in the email (which may include a video clip, photo, or written reflection) and consider giving your consent for it to be used in connection with educational or promotional materials for Thrive This Time, LLC or Chesapeake Paradise. With your permission, we may share these selected clips, photos, or reflections so others can better understand what this work is like and how it supports people.

When you agree to share these moments, you are helping bring to life the real experiences of those who have benefited from retreats, groups, or private coaching. Many see this as a way of “giving back and paying forward” the changes they’ve experienced in their own lives. These reflections offer others a genuine glimpse into what it can feel like to be met with care, curiosity, and choice.

The form below allows you to approve, edit, or decline the material referenced in your email, as well as choose how your name is displayed or select your preferred level of anonymity.

Email *

First & Last Name *

May we use the photo(s)? *

Yes, you may use the photo(s)

Please do not use the photo(s)

Not applicable

Please review the photo(s) using the link in the email and provide your permission here. (Select “Not applicable” if no photos are included.)

May we use the video clip(s)? *

Yes

Yes, but please edit or shorten it

No video please

Not applicable

Please review the video using the link in the email and provide your permission here. (Select “Not applicable” if no videos are included.)

Suggested Edits to the Video Clip (Optional)

If you approved the video but would prefer that certain parts be shortened, removed, or edited, please let us know below. You can reference a moment in the clip (for example: “around 1:20–1:40”) or describe the portion you'd prefer not to include.

How would you like your testimonial attributed?

First name only

First and last name

First name + title or identifier (for example, "CEO & Grandmother" "Empty-Nester from Texas" etc.)

Anonymous

If using your name or title, write it exactly as you'd like it shown, including if you want to *

(write N/A if applicable)

May we use a photo with your testimonial? (if necessary)

You may use a photo from my social media

I will send a photo

No photo please

Upload a photo you'd like us to use with your testimonial (optional)

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF If you prefer a specific photo to accompany your testimonial, you may upload it here.

Legal Permission

I give permission for Shawn Mahshie and her team at Thrive This Time, LLC., to use my written reflections, testimonials, photographs, and/or video or audio recordings from programs, retreats, coaching sessions, or group calls in connection with educational or promotional materials, including websites, social media, courses, presentations, emails, publications, and advertising (such as online ads).
This permission applies only to the specific material reviewed here and does not expire. Any additional materials would require separate permission.
I understand that granting this permission is voluntary, and that no adverse or different treatment will result from my decision not to provide consent. I also understand that I will not receive compensation for this use.

Permission *

I grant permission as indicated above

Digital signature *

Thank You

Thank you for taking the time to review and submit this form!
Your willingness to share your experience helps others see that real change is possible. For many people, hearing from someone who has already walked this path can make the difference between feeling alone and discovering that support and new possibilities exist.
We deeply appreciate your time, your voice, and the ways you help this work continue to reach those who may benefit from it.

Shawn and Team