"UNBREAKABLE GLASS" PODCAST GUEST INTAKE & RELEASE FORM
  • "UNBREAKABLE GLASS" PODCAST GUEST INTAKE & RELEASE FORM

  • Personal Information

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  • I, _______________________, grant permission to Glass Studios – Unbreakable Glass Podcast LLC, hereinafter known as the “Media” to use my image (photographs and/or video) for use in Media publications including:

    (Check All That Apply)

     ☒-Videos ☒-Pictures ☒-Social Media ☒-Newsletters ☒-Magazines                       ☒-General Publications ☒-Website and/or Affiliates ☒-Other: _____________

    I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.

     

    Please initial the paragraph below which is applicable to your present situation:

     

    _____ - I am 18 years of age or older and I am competent to contract in my own name. Ihave read this release before signing below, and I fully understand the contents, meaning and impact ofthis release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of thisrelease.

    _____ - I am the parent or legal guardian of the below named child. I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

     

    Signature: ____________________            Date: _______________________

    Name (please print): _______________________________

    Signature of parent or legal guardian: ________________________________

    (if under 18 years ofage)

  • By signing this form,

    I hereby accept that I have read and understood the acknowledgment letter provided above.

    I declare that the information I have provided above is correct.

    I am giving my full consent to get the COVID-19 vaccine of my own will.

     

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