CONTENT/FORMS

Title of the Form:

Lesbian Birthday Wishes – Video Submission Form

Form Description:

Thank you for your interest in contributing to Lesbian Birthday Wishes, a short global documentary featuring lesbians of all ages reflecting on their birthdays. Please complete this form and upload your video below.

Form Fields:

1. Full Name (Short answer – required)

2. Date of Birth (Date – required)

3. Age (Short answer – optional)

4. Location of Video (City & Country) (Short answer – required)

5. Birthday (Month & Day) (Short answer – required)

6. Email Address (Short answer – required)

7. Social Media: TikTok, IG, X, FB, website, Other (checkbox and field for each – required)

8. What are the top three things you’ve learned this past year? (Short answer – one word header for each of three answers, short open text box below – required)

9. What are the top three things you wish for yourself, or for the world, in this next year? (Short answer – one word header for each of three answers, short open text box below – required)

Permissions & Consent Waiver:

The nature of your submission might include personal elements, which might become public in this process. Please consider this carefully. By submitting this form and video, you confirm the following:

    I grant the filmmaker, Dr. Nadine Greiner, and her collaborators the non-exclusive, perpetual, worldwide right to use, edit, reproduce, distribute, and exhibit my submitted video, in whole or in part, in the documentary Lesbian Birthday Wishes and in any associated materials (including promotional, educational, festival, and digital distribution formats).

    I understand that I will not receive financial compensation for my participation or for the use of my image, voice, or submitted content, now or in the future.

    I confirm that I am at least 18 years old, and that all content submitted (including visuals, audio, and language) is my own and does not infringe on the rights of others.

    I give consent for my name, likeness, voice, and location (city/country) to appear in the film and related media, unless otherwise agreed upon in writing.

    I understand that submission does not guarantee inclusion in the final project. Selection is based on creative, editorial, and logistical factors, and is not a reflection of the quality or importance of my story.

    I understand that I may withdraw my submission at any time prior to the film’s public release by emailing the filmmaker, and that my request will be honored to the extent reasonably possible. I acknowledge that once the film is finalized and distributed, withdrawal is no longer possible.

Hold Harmless & Liability Waiver

I hereby release, discharge, and agree to hold harmless Dr. Nadine Greiner, her associates, partners, contractors, crew, editors, successors, licensees, distributors, and all persons and entities involved in the production or dissemination of Lesbian Birthday Wishes (collectively, “the Filmmakers”) from any and all liability, claims, demands, damages, or actions, of any kind, whether known or unknown, arising out of or relating to:

    my participation in the project;

    the use of my submitted materials, likeness, voice, or personal story;

    editorial decisions, including omission or inclusion of content;

    and any loss, injury, or damages resulting from technical issues, distribution, reputation, or otherwise.

This waiver expressly includes, but is not limited to, claims based on negligence, defamation, emotional distress, infringement of rights, or breach of privacy, as well as any unforeseen events, force majeure, or acts of God.

I acknowledge that this release is binding, irrevocable, and applies in all media formats, languages, markets, and territories now known or hereafter developed.

[Checkbox] I have read and understood the above terms and give my full permission for the use of my video and information as described.
[Short Answer] Typed Name (serves as electronic signature)
[Date Field] Date of Submission