Terms and Conditions

Full Name: ____________________________________

Preferred Name / Nickname (if any): _______________________

Mobile  Number: ________________________

Email Address: ________________________

Emergency Contact if Need support (optional): ___________________________

YOUR STORY SNAPSHOT

1. In a few words, how would you describe your story or the main challenge(s) you’ve been through?

(Optional – just a few sentences to help guide the conversation.)

CONSENT & COMFORT ZONE

2. Do you consent to being interviewed on the “Who Wants to Be a Hero?” podcast and sharing your story publicly (audio format)?

☐ Yes, I consent

☐ No, not at this stage

☐ I’d like to discuss more before deciding

3. Are you okay discussing the following areas during the podcast?

(Tick what you’re comfortable with – all optional.)

☐ Mental health

☐ Financial struggles

☐ Relationship breakdowns

☐ Addiction or recovery

☐ Youth challenges / identity

☐ Family trauma

☐ Loneliness or isolation

☐ Chronic illness or disability

☐ Grief and loss

☐ Legal trouble or justice system

☐ Career/job burnout or change

☐ Other: _______________________________________

DEPTH + DIRECTION

4. How raw would you like to go?

(Select what best describes your comfort level.)

☐ Let’s keep it light – just surface stories and general reflections

☐ Honest but edited – open to real talk but with some boundaries

☐ I’m ready to go deep – raw, vulnerable, emotional, the real stuff

☐ We’ll see how I feel on the day

5. Current mental health status (optional but helpful):

☐ Feeling strong and stable

☐ Mostly in control, a few ups and downs

☐ Bit wobbly – not in the best place

☐ In the thick of it – struggling right now

☐ Prefer not to say

SUPPORT + SAFETY CHECK

6. Is there anything off-limits for the interview?

(Topics, words, names, or triggers you want us to avoid.)

7. Is there anything we can do to help you feel more supported or safe during the interview?

FINAL CONSENT

☐ I understand this podcast is about real stories and agree to share mine in a way that feels right for me.

☐ I know I can pause, skip questions, or ask for edits at any time before the episode goes live.

☐ I trust Matt and the team to handle my story with respect and care.

Signature: ______________________

Date: __________________________