Photo Requirements
File Format: Jpeg or TIFF
Resolution: preferable 300DPI or higher (if using a lower quality camera, must be at least 96DPI and absolutely clear)
> Face area must take up at least 25% of the photo
Include 2 good quality photos. One photo taken before any surgeries and one most recent photo. (not a requirement)
> Email your photos along with this completed form to
Submission Information
*If the contributor is a child, parents may assist their child with answering questions, but please refrain as much as possible from any help in the story part of the submission.
* We want to be sensitive to your privacy. Therefore, you have the choice to have your name or your child’s name as a pseudonym. If you would like to choose this, write alternate name in number 3 below.
*Please complete all three sections below, including the permission release at the end*
Section One
1.Writer’s Full Name:
2.If writer is a minor, Parent/Guardian’s Full Name:
3.Name of individual starring in your story:
4.Writer’s email:
5.If under 18 years of age, Parent/Guardian’s email:
6.State/province and country of residence:
7.Cleft type:
8.Birthdate (month/date/year):
9.Number of surgeries:
10.Types of surgeries:
11.Therapies or medical treatments gone through (speech, occupational therapy, physical therapy, dental work…):
12.Labels are placed on us all the time by friends, family, strangers, ourselves, etc.; they may be negative or positive. I encourage you to think about them and LET GO of the negative. You are an amazing person, no matter what others think. If you were to choose one positive ‘label’ about yourself, what would it be?? So, please finish this sentence, “I AM….”
Section Two **Story Submission**
Remember to fill out the release form on the final page.
1. Optional: write a letter to someone going through what you have gone through. Give advice, encouragement, etc. (‘Dear expectant parent…’ or ‘Dear Courageous Child…’) - - 100-300 words (feel free to write one of each type of letter, whether you’re a parent or cleft affected child.) sign off the letter how you would like it to look in the book (e.g. “love, someone who’s been there” “take care, from your friend Joe” …)
2. Story Submission (1500 words max)
Section Two **Author Permission Statement**
Julie Cwir will hereby represent and be referred to as I Wish I’d Known…
I, will hereby be referred to as ‘Author.’ (An author that is under the age of 18 years, must have signed parental consent)
The Author represents and warrants that he or she is the author or creator of, or otherwise has acquired all rights in, the photos and/or information submitted. Author represents and warrant that the work and submitted materials does not infringe any copyright or violate any other right of any third parties, that the work and submitted materials has not been published elsewhere in a manner that would affect I Wish I’d Known…’s rights to publish said work and materials.
Author understands that his or her submission is not guaranteed to be selected for publication and will not be compensated by any monetary fee or reward.
Author grants permission for the inclusion of submitted materials if selected. Author hereby grants I Wish I’d Known… the limited, non-exclusive right to use the photos and/or information submitted herewith in the following manner: (1) as part of I Wish I’d Known…, whether in print or electronic/digital format; and (2) for purposes of promoting or advertising I Wish I’d Known…. Author understands and agrees that the photos and/or information may be edited for size, length and/or clarity.
Read and complete if you are a parent/guardian submitting a story ABOUT your minor child:
I represent and warrant that I am the true parent or legal guardian of the minor child depicted in materials submitted to I Wish I’d Known... and have full right and authority to use and authorize the use of the photos and/or information submitted to I Wish I’d Known… .
Read and complete if you are a parent/guardian submitting a story FOR your minor child:
I am the parent or legal guardian of above individual referred to as ‘Author.’ I represent and warrant that I am the true parent or legal guardian of the minor child depicted in materials submitted to I Wish I’d Known... and have full right and authority to use and authorize the use of the photos and/or information submitted to I Wish I’d Known… . I hereby, give permission to I Wish I’d Known… for these submitted materials to be printed by I Wish I’d Known… . I have read the above author permission statement and authorize my child permission to submit his or her story and submission materials based on this agreement.
Author Full Name:
The author agrees to the above release by signing with an “X” :
Parent/Guardian Full Name (if applicable):
Parent/Guardian (if applicable) agrees to the above release by signing with an “X” :