Name *

First Name

Last Name

Select a topic of the challenge you're facing: *

Relationships

Health

Mental Health - Anxiety, Depression

Finances

Career

I consent to having my voice and video played on the Peter Crone project if my clips are selected. (If not please close out of this form.) *

This Agreement (“Agreement”) is made in consideration of participation in the program (“Program”) offered by Peter Crone and his affiliates (“Producer”), and for other valuable consideration. I acknowledge that the Program is recorded for commercial purposes. I hereby grant Producer the perpetual and unconditional right to use all recordings, including images, video, voice-over, and likeness, for any purpose related to the Program, including advertising and exploitation, worldwide and in perpetuity. I understand that Producer owns all rights to the Program and that I have no financial claims. I confirm I am over 18 years old and have the right to enter into this Agreement. I acknowledge that I have not relied on any promises not stated herein. I agree that Producer can assign this Agreement to any third party. Any disputes will be resolved by binding arbitration in Clark County, Nevada, with the prevailing party entitled to fees and expenses. I have read and understand this Agreement and participate in the Program willingly.

Yes, I consent.

I understand I must submit 1 video to be considered. *

Yes