Parents! Want to ask a question on the show? Please fill out the form below and we’ll be in touch! Your Name * Email * Date of Birth * MM DD YYYY Phone (###) ### #### Tell us about you * How old are you and how old are your kids? Issue or topic to discuss on the show * Can you join a Zoom to appear on the show? * Yes No Are you available on Wednesday, January 18th from 10am-6pm PST? * What time of day would you be able to appear? Link to any photos or videos? http:// Consent * By checking this box, I hereby grant and authorize the Daddy Vs. Doctor Podcast and Youtube show the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all video and/or audio taken of me to be used in and/or for any lawful purpose. This authorization extends to all languages, media, formats and markets now known or later discovered. This authorization shall continue indefinitely, unless I otherwise revoke this authorization in writing. I waive the right to inspect or approve any finished product in which my likeness appears or is heard. I agree that I will not be compensated for this use of my likeness or have otherwise agreed to this release without being compensated. I waive any right to royalties or other compensation arising or related to the use of the video and/or audio. I understand and agree that these materials shall become the property of the Daddy Vs. Doctor Podcast and YouTube show and will not be returned. I hereby hold harmless and release the Daddy Vs. Doctor Podcast and YouTube show, Sebastian Maniscalco and Dr. Scott Cohen from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate. Yes Thank you!
