I, the undersigned, do understand that the Prairieland Paranormal Podcast, produced by Eric and Jessica Carrier (the “Podcast”), creates and publishes podcasts, websites, blogs and other works regarding personal and public experiences with the paranormal for informational and entertainment purposes. I hereby express my intent and desire to participate in creating works suitable for use by the Podcast through personal interviews and/or submission of written, artistic, photographic and/or audio/visual works. *

Therefore, I do hereby consent to the use by the Podcast of (1) any video, photograph, performance, interview, writing, audio recording and/or other creative work in which I participate or which I submit to the Podcast, including my name, recorded voice or video, photograph or likeness, and biographical information; and (2) any reproductions, advertising, publicity, summaries, transcriptions, editorials, and/or derivative works derived in whole or in part therefrom. *

IN ADDITION, I WAIVE AND RELEASE ALL CLAIMS TO COMPENSATION OR DAMAGES BASED ON THE ABOVE STATED USES (INCLUDING, WITHOUT LIMITATION, CLAIMS FOR INVASION OF PRIVACY, DEFAMATION, OR RIGHT OF PUBLICITY) ARISING OUT OF OR IN CONNECTION WITH ANY USE, ALTERATION, OR USE IN COMPOSITE FORM OF ANY OF THE ABOVE. *

I warrant and agree that my participation, interviews and submissions have not and will not violate the rights of any third parties, including but not limited to copyrights, rights of privacy, trade secrets, and non-disclosure agreements, and that in the event of any breach of any of these warranties, I will defend and hold the Podcast harmless from and against such claims. *

This consent, waiver and release shall be binding upon me, my heirs, legal representatives, and assigns. *

By completing this form and submitting it to the Podcast, I do so attest. *

I am at least 18 years of age and am competent to enter into this agreement.

I have read this form and fully understand its contents.

Name *

First Name

Last Name

Date *

MM

DD

YYYY