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Guest Info Request

Pushing Forward Guest Info

Thanks for agreeing to be a guest on the Pushing Forward with Alycia podcast. The goal of the podcast is to hear your story, to learn about your work, business or advocacy and how it helps to bridge the gap to a more diverse and inclusive society.
Please be ready to share with our audience how you are pushing forward in your life. We would love to hear your stories of resiliency and how you have had to push through fear, anxiety, challenges, or obstacles to get through to the other side to hope for a better tomorrow.

Minor Guest Consent, Release & Waiver (Podcast)

Show/Producer: Pushing Forward with Alycia, produced by The Alycia Anderson Company, LLC

Recording Date(s): TBD • Location/Method: Virtual Platform

1) Consent to Record

I am the parent/legal guardian of the Minor named above. I consent to the audio/video recording of the Minor’s interview/performance for the Show, including any behind-the-scenes content and still images.

2) Grant of Rights (Use of Voice/Name/Likeness/Story)

I grant to Producer a worldwide, perpetual, irrevocable, royalty-free, transferable and sublicensable license to record, edit, adapt, transcribe, reproduce, distribute, publicly perform, and display the Minor’s appearance, name, voice, likeness, biographical information, and contributed content in any media now known or later developed, including podcasts, videos, transcripts, ads, social media, publicity, promotions, and licensing to third-party platforms.
I waive any right of approval/inspection over the final versions. Producer has no obligation to use the recording.

3) No Compensation

I understand the Minor will not be paid and there is no expectation of compensation or credit beyond what Producer elects to provide.

4) Release of Claims

To the fullest extent allowed by law, I (for myself and on the Minor’s behalf) release and discharge Producer, its owners, officers, employees, contractors, licensees, and assigns from any and all claims arising out of the recording, editing, distribution, or use of the Minor’s appearance and related materials, except claims resulting from Producer’s gross negligence or willful misconduct. This release includes claims for violation of rights of privacy/publicity, defamation, and intellectual-property claims in the Minor’s contributed statements.

5) Assumption of Risk & Waiver

We understand participation may involve ordinary risks (e.g., travel to/from venue, being on camera/mic, live or remote recording). We assume these risks and waive claims related to them, except where such waiver is not permitted by applicable law.

6) Parent/Guardian Representations & Indemnity

I represent that I am the Minor’s legal parent/guardian with full authority to grant these rights. I agree to defend, indemnify, and hold harmless Producer from claims brought by or on behalf of the Minor (including after the Minor turns 18) or by third parties arising from the Minor’s statements or my lack of authority—except to the extent caused by Producer’s gross negligence or willful misconduct.

7) Privacy & Data

I consent to Producer collecting, storing, and processing the Minor’s personal information (e.g., name, contact details, recordings, transcripts, images) for production, distribution, marketing, and archival purposes, consistent with Producer’s privacy practices. I understand I may request deletion or restrictions where required by law by contacting: alycia@alyciaanderson.com.

8) Sensitive Topics

I understand the interview may address personal experiences. I may decline any question or stop participation at any time before or during recording. Producer may continue to use content recorded prior to withdrawal, subject to law.

9) Accessibility & Conduct

Producer will make reasonable accommodations upon request. We agree to follow reasonable directions to ensure a safe, respectful recording environment.

10) Miscellaneous

  • Governing Law/Venue: California / United States of America.
  • Severability: If any provision is invalid, the remainder still applies.
  • Entire Agreement: This is the full agreement about the subject.
  • Assignment: Producer may assign these rights.
  • E-Signature/Counterparts: Electronic signatures are valid.
Parent/Guardian
Parent/Guardian
First Name
Last Name
Consent
Name
Name
First
Last

Maximum file size: 10MB

Maximum file size: 5MB

https://example.com
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Social Media Links

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Other Social Links

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Website/URL

Admin Fields

Recording Time

Maximum file size: 134.22MB