Podcast Release Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Podcast Episode
1
2
3
4
5
6
7
8
9
10
Your Age
Younger than 18
18 or older
Parent/Guardian Name
First Name
Last Name
I, undersigned, agree with the following statement
I consent to the audio recording of my or my/my child's interview.
I grant ABC Podcasts the right to use the recording for any purpose.
Date
-
Month
-
Day
Year
Date
Signature
Submit
Submit
Should be Empty: