Podcast Guest Interest Form
Hello! Thank you so much in your interest in being a special guest on 'Between A Rose and A Thorn' podcast. 

Details: 
Passed episodes can be found under the name 'Be The Link'
Each episode is 30-60 minutes long
Be ready to share the one thing that helps you get through a hard time. 

Are you interested in sponsoring an episode or season? Please email Leia - Leia@leiaskids.org

If you have any questions please reach out to info@leiaskids.org and we can help you. 


Thank you, 
Leia's Kids Team 
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First and Last Name *
Email *
Cell Phone *
Bio or a few sentences about YOU! *
Whats the one think that helped YOU get through a hard time? *
Instagram
Facebook Page/Link
Website

By checking this box, I give my permission for Leia's Kids Foundation and/or its representatives to use artwork, photographs and/or letters/the story that I provide of my child, my family, and/or myself in publications, slides, videotapes, motion pictures and/or on the Internet. In addition, I hereby give my permission for Leia's Kids and/or its representatives to photograph, audio tape record, and/or videotape my child or myself and to use our names, these images or voice recordings in publications, slides, videotapes, motion pictures and/or on the internet. I understand these visual images or voice recordings may be used to inform families, volunteers, donors, the media and general public about Leia's Kids programs, services or events. I gladly give this authorization to support the efforts of Leia's Kids. I understand this authorization shall continue until terminated in writing. Providing consent is not a requirement in order to participate in Leia's Kids programs.


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By checking the box, I give permission to be contacted about Leia's Kids by SMS text at my residential or cellular number or provided email address, dialed manually or by autodialer (consent to be contacted is not a condition to participate) and to be contacted via email. I consent to be contacted even if my phone number or email address appears on a Leia's Kids Do Not Call / Do Not Email List, a State or National Do Not Call Registry, or any other Do Not Contact List.
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Required
By checking this box, I agree to conduct myself in a polite and respectful manner towards all other attendees, staff, volunteers, and any other individuals when attending an Leia's Kids Foundation event consistent with core values of the organization.
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Required
Please let us know if you have any questions or concerns!
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