Please read the statement below and if you agree please fill out and submit the form at the bottom of the page.

For good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, I hereby grant Fixing Dad Ltd, and its licensees, designees and assignees (collectively "Producer"), the absolute and irrevocable right and permission to photograph, film, videotape, record and/or portray my name, voice, portrayal, actions and/or likeness in connection with Producer's  television program and/or series currently entitled “Fixing Dad” (the “Program,” my appearance, an “Appearance”) which shall consist  of  filming my health journey and to use the results and proceeds thereof (collectively the "Material") as follows:


(a) To copyright the Material in Producer‘s own name or in any other name (the Material shall be considered a "work made for hire"); 

(b)  To use, incorporate, broadcast, distribute, re-use, publish, re-publish, alter and/or edit the Material and/or my name, likeness and portrayal in whole or in part, severally or in conjunction with other material (including in the main or end titles) for any purpose and in any manner whatsoever as Producer so chooses in any and all media, now known or hereafter devised, in any and all versions, throughout the universe and in perpetuity, as well as for promotion, merchandising, publicity and advertising.  Producer has no obligation to use the Material, my name, voice or likeness.  I acknowledge that my appearance in advertisements or promotions of the Program constitutes part of my Appearance services and that I shall not be entitled to any compensation for such.   I understand that all rights in and to the Material, including the negatives, outtakes, sounds and the images contained therein, shall be Producer's sole and absolute property.


I acknowledge and agree that the Material is personal, sensitive and confidential and can only be shared by me, particularly but not exclusively on social media, when and on a basis pre-agreed with Producer.


I represent and warrant that I have the right to grant Producer the above-mentioned rights without obtaining the permission of, or making any payments to, any third party or entity.  I hereby release Producer, its successors, assignees, licensees and affiliated entities from, and covenant not to sue Producer for, any and all claims or cause of action, whether known or unknown, including without limitation, defamation (including libel and slander), invasion of right of privacy, infringement of my right of publicity or personality, or any other claim or cause of action, based upon or relating to the use of the Material and any other personal or property right, or the exercise of any of the rights referred to herein.  I agree to indemnify and hold harmless, and agree that I shall not now or in the future assert or maintain any such claim against Producer and any person claiming under Producer, its partners and all affiliated companies thereof and their respective officers, directors, partners, shareholders, employees, agents and representatives thereof, from and against any liabilities, losses, claims, demands, costs (including without limitation attorneys'  fees) and expenses arising in connection with any breach or alleged breach by me of any of the above representations, warranties or agreement hereunder.


I acknowledge that, in the event of any breach by Producer or any third party, the damage, if any, caused me thereby will not be irreparable or otherwise sufficient to entitle me to seek injunctive or other equitable relief.  My rights and remedies in such event will be strictly limited to the right, if any, to recover damages in an action at law, and I will have neither the right to rescind or terminate this agreement or any of Producer’s rights hereunder, nor the right to enjoin the production, exhibition, or other exploitation of the Program or any subsidiary or allied rights with respect thereto.  This release constitutes our entire understanding and agreement with respect to the subject matter hereof and cannot be amended except by a written instrument signed by the parties hereto.  This release will inure to the benefit of and will be binding upon our respective affiliates, successors, licensees, assigns, heirs and representatives. This release will be governed by the laws of England and Wales and the parties submit to the exclusive jurisdiction of the English courts.


I acknowledge that I have had explained to me, and I fully understand, the full nature of the Program and my participation in it and I agree to so participate.  In particular, I acknowledge that, although the Program involves the filming of my health journey, that the Producer is not a healthcare or medical professional or advisor of any kind.  


I understand that there is a possibility of i) risk of injury to me or others and/or ii) damage to either my property and/or the property of a third party as a direct and/or indirect result from my participation in or connection with certain activity(ies) which may be included within the production of the Program.  I hereby agree and acknowledge that I am voluntarily participating in this activity(ies) for possible inclusion into the production of the Program with full and complete knowledge of the risks and dangers involved in the said activity(ies), and I hereby agree to accept and assume any and all risks of any nature whatsoever of personal and emotional injury and/or property damage of any nature whatsoever on their behalf or of any heir, dependent, spouse or significant other, and I shall hold Producer, its partners and all affiliated companies thereof and their respective officers, directors, partners, shareholders, employees, agents and representatives harmless from and against any claim, demand, liability or judgment, including reasonable attorneys' fees and court costs, arising out of any injuries sustained by me during my Appearance.


I understand that Producer has been induced to proceed with the production, distribution and exploitation of my Appearance in reliance on this agreement, but nothing herein shall obligate me to render an Appearance.


By necessity Producer will process my personal data, including image and voice, as part of producing the Program. Producer will do so in accordance with all relevant data protection law and you can find out more information about how Producer processes your personal data here: