Skype will be used for the chat.

When the video goes up, you will have the option to choose whether your name/youtube username goes up with the video.  Anonymity can be requested. However, we do need to know your username here. Thank you for understanding.

This can be anecdote/story based, or a question you want to ask me that will lead to a broader conversation you want to have. It can be about absolutely anything (i.e. body image, mental health, cyberbullying/bullying, family dynamics, friends, self love, fears, school pressure, etc). This is not about me, it is about YOU. I want to hear your story. Let's have a conversation :) The more SPECIFIC you are in terms of a personal story, the better.

BY CHECKING THE BOX AT THE END OF THIS RELEASE FORM, I (THE “PARTICIPANT”) HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS: For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged by each of the parties hereto, Participant hereby grants to Jacqueline Emerson (“Producer”) and Producer’s affiliates, subsidiaries, successors, assignees and licensees (collectively, the “Released Parties”) the right to interview, photograph, videotape, create audio recordings, and/or otherwise film and/or record Participant and the irrevocable, unconditional, and unrestricted right (but not the obligation) to use such interviews, photographs, audio recordings, video recordings, audiovisual recordings, and/or related material (collectively, “Materials”) including, without limitation, the right to use Participant’s name, image, biographical material, voice and/or likeness (“Attributes”) in, and in connection with, promotions, publicity, and advertising respecting the project currently entitled “Let’s Get Real” and such other audiovisual productions as Producer may determine (collectively, the “Project”) and in, and in connection with, advertising, publicizing, promoting, exhibiting and otherwise exploiting the Project, in whole or in part, by any and all means, media, devices, processes and technology now or hereafter known or devised, in perpetuity throughout the universe.  Participant acknowledges that Producer (and ultimately one or more of the Released Parties) shall own all right, title, and interest (including, without limitation, the copyright) in such Materials. Participant hereby releases the Released Parties from any and all claims and demands arising out of or in connection with the Project, Attributes, and/or Materials including, without limitation, any and all claims respecting invasion of privacy, copyright infringement, rights of publicity, defamation and any other personal and/or property rights. Participant acknowledges that (i) Participant will not be entitled to any additional payment for any use, reuse, sale, or other exploitation of the Project, Materials, and/or any work which incorporates any part of thereof; (ii) Producer shall have no further obligation to Participant, either monetary or otherwise; and (iii) Producer and Released Parties have no obligation to use any Materials and/or Attributes in connection with the Project or otherwise. Participant hereby confirms that Participant has the authority to grant to the Released Parties the right to use Participant’s Attributes and that Released Parties’ exercise of such rights shall not violate or infringe any rights of any third party.  Participant understands and acknowledges that the Released Parties have been induced to proceed with the Project and the production, distribution and exploitation of the Materials in reliance upon this release. Participant acknowledges and agrees that Participant’s sole remedy for any breach or alleged breach in connection with this Agreement, the Project, and/or the use of the Attributes and/or Materials shall be an action at law to recover such damages as may have been actually suffered as a result thereof.  Participant hereby waives Participant’s rights, if any, to enjoin, restrain, interfere or seek injunctive relief with respect to the Project and/or the exploitation of the Attributes and/or Materials. Participant irrevocably guarantees and warrants that Participant is not a minor and will not disaffirm or disavow the Agreement for any reason (including, without limitation, on the grounds that Participant is a minor at the date of the execution thereof, or on any other similar grounds).  Further, the undersigned agrees to indemnify Producer and its associated, affiliated and related entities, parent, successors, assigns, licensees against any and all damages, costs, losses, expenses (including reasonable attorneys' fees and legal costs), and liabilities of any kind or nature whatsoever that arise out Participant’s breach of the Agreement or the disaffirmation or attempted disaffirmation by Participant of the Agreement.    Participant hereby confirms that this Agreement shall be governed by, and construed in accordance with, the laws of the State of California, excluding (to the fullest extent a California court would permit) any rule of law that would cause application of the laws of any jurisdiction other than the State of California.  Participant hereby irrevocably and unconditionally submits to the exclusive jurisdiction and venue of the Courts of Los Angeles County, California, for any action or proceeding arising out of or relating to this agreement.  I ACKNOWLEDGE THAT I HAVE READ THE FOREGOING AND I FULLY UNDERSTAND THE CONTENTS. BY CHECKING THE BOX BELOW, I, THE PARTICIPANT,  AM GIVING YOU THE EQUIVALENT TO MY ELECTRONIC SIGNATURE AND THEREFORE AGREEING TO ALL THE ABOVE.

In the interest of her privacy, Jackie will be blocking all accounts after Skyping with them. This is nothing personal, it is merely protocol, and she cannot make any exceptions. Thank you for understanding!