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The Survivor's Crayon

Please fill out the form to be added to the previous page.  
Click on "submit" when you are done.

Your name:

Your email address: (e.g.:

What are you a survivor of (incest, abuse, self-injury, etc.)?

How old are you?

(Optional) When you are feeling down, what is one thing or person that motivates you to keep going?

(Optional) How has being a survivor changed your life?

*Your answers will be posted within 48 hours*
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