Guest Release Form

Please review the form before your recorded interview. If you have questions about the permissions requested, contact the show team before signing.

Step 1 of 2

Your name *

Email *

Phone *

Are you over 18? If not did your parents sign for you? *

Yes No

Select if your parents signed for you?

Address *

I consent to the audio and video recording of my interview and grant Chase & Embrace Show the right to use it for any purpose. *

I agree

Will you subscribe to Chase & Embrace on YouTube? (not required)

Yes No Maybe

Do you agree to promote your episode on Chase & Embrace once it airs?

Yes No Maybe

If you're on the show, please include all of your information to be placed on the video's description

NOTE: i.e. your website, social media and etc...

Signature

Signature Full Name

If the form above is not working, please fill in your full and complete name for legal reasons.

Chase & Embrace Show Guest Release Form