First Name *
Last Name *
Email *
Cell Phone *
City *
State *
Please provide your date of birth *
Please provide the name, age, and location of the Ex you are seeking to get back together with. *
Please tell us how you met your Ex? *
How long were you married to your Ex? *
What caused your marriage to end? *
Why would you like to get back together with your Ex? *
Is your Ex single, or are they currently in a relationship with someone else? If they are in a relationship, how long have they been with that person? *
How long have you and your Ex been separated? *
What type of relationship do you currently have with your Ex? *
Please provide us links or handles to any social media pages you have. *
Please provide a recent photo of yourself *
Please provide your favorite photo of you and your Ex *
Please provide the most recent picture of you with your Ex *
In consideration for my possible appearance in the reality-based television program currently entitled “Untitled Divorce Project” (working title) (the “Program”) being developed by JamCam Productions LLC (“Producer”) and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby agree as follows: 1. My Story. In connection with my casting application (“Application”) to be a potential participant in the Program (if selected by Producer), I will be asked by Producer to share information about myself and/or people close to me (“Information”). As part of the casting process, I may also be asked to supply photographs, home movies, etc. (“Material”). 2. Accuracy. All statements I make to Producer and all Information I provide in connection with my Application will be accurate and true. No third-party rights will be violated by supplying the Information and/or Material to Producer, or by Producer and Distribution Entities’ (defined below) use of the Information and/or Material in or in connection with the Program. If any of the Information provided by me in connection with my potential participation in the Program is found to be false, misleading or incomplete, this may be grounds for removing me from the casting process or ending my participation in the Program itself, if selected. 3. Rights Granted. I grant to Producer and any television network or station broadcasting, exhibiting, or otherwise distributing the Program, and each of their respective assigns, successors, parent, affiliated and subsidiary companies and their respective licensees and advertisers (collectively, the “Producer and Distribution Entities”), the irrevocable, non-exclusive right and license (but not the obligation) to: (i) tape, photograph, film, record, use and/or reuse my name, likeness, sobriquet, voice, personality, image (collectively “Likeness”) in and in connection with the Program, (ii) use any and all Information (including, without limitation, medical information which may be revealed by me or parties close to me) in or in connection with the Program or otherwise to the greatest extent permitted by law, (iii) to change, modify, reenact and record my story and/or the Information in whole or in part in and in connection with the Series (iii) use the Material (or any part thereof) in any manner, by any and all such means and for such purposes as Company designates in its sole discretion, in any and all media and/or method now known or hereafter devised and/or discovered throughout the universe in perpetuity. My contribution to the Program is specially ordered or commissioned by Producer as part of an audiovisual work as a work made for hire for Producer. 4. Use of Materials Supplied by Me. I understand that Producer may make edits or changes to the Information and Material for a variety of reasons (such as to edit for time, etc.). To the maximum extent permitted by law, Producer has the right to use all information obtained about me in connection with the Series or otherwise including, without limitation, medical information which was revealed by me or parties related to me in connection with the Program. I understand that the use of my Likeness, Information and/or Material in the Program could be embarrassing, disparaging, surprising, of an unfavorable nature, factual or fictional, or portray me or persons close to me in a false light. I warrant and represent that I have all rights, licenses, permissions and consents necessary to submit the Information and the Materials and to grant all of the rights that I have granted to Producer herein (including, without limitation, any permissions and/or consents necessary for individuals references or appearing in the Information and/or Material). 5. Release of Claims. I will not assert or maintain, or consent that others assert or maintain, any claim or action of any kind whatsoever against Producer or any of the Producer and Distribution Entities arising out of, resulting from, or by reason of my Application; the application process for the Program itself; Producer’s use of the Information and/or Material; anything contained in the Program or in the advertising or publicity issued in connection therewith; or the use by Producer or its successors, licensees or assigns of recordings made of me in connection with the Program violates any of my rights or portrays me in a defamatory, false and/or negative light. 6. Indemnity. I unconditionally and irrevocably agree to defend, indemnify and hold harmless each of the Producer and Distribution Entities from and against any and all claims, demands, liens, agreements, contracts, actions, suits, costs, attorneys’ fees, damages, judgments, orders and liabilities of any kind or nature in law, equity or otherwise, by whomever asserted, arising out of or in connection with (i) my breach or alleged breach of any agreement, covenant, representation, warranty in this Agreement (ii) arising out of or in connection with my Application, the Information and/or Materials, or (iii) the malfeasance and/or negligence and/or other tortious acts or omissions committed by me or people close to me. Producer may elect to take such action on behalf of itself and/or as attorney-in-fact for me to adjust, settle, defend or otherwise dispose of such claim, in which case I shall, upon being billed therefore, reimburse Producer and Distribution Entities. 7. Restrictions on Publicity. I will not myself, or authorize others to (a) publicize or promote my appearance, or potential appearance, on the Program by any means, or (b) disclose to any party any confidential information obtained or learned as a result of my participation in the Program. As used herein, "confidential information" includes (without limitation) the identities of participants in the Program, events which take place as part of the Program, and the outcome or contents of any episode of the Program. 8. Other Agreements. If Producer selects me for further consideration in the participant selection process, I will be asked to complete and execute further agreements (collectively “Participant Agreements”). I acknowledge and agree that unless and until I execute such Participant Agreements, Producer may choose not to consider me as a possible participant for the Program. Without in any way limiting my representations and obligations hereunder, at Producer’s request I shall obtain and/or produce releases, in a form approved by Producer, from such persons as Producer may deem necessary, including but not limited to individuals included or referenced in the Materials. 9. Additional Casting Activities. I may be asked to participate in interviews with Producer via videoconference or otherwise (which may or may not be recorded by Producer) and must be willing to do so if requested, and I acknowledge that Producer, in its sole discretion will determine who among the people interviewed will be placed into the pool of potential participants. I shall voluntarily submit to a background check and/or medical and psychological testing, if and as requested by Producer (and agree to execute all consents and releases in connection therewith). I understand and agree that all decisions by the Producer concerning the selection of the participants are final and not subject to challenge or appeal. 10. Miscellaneous. I hereby represent and warrant that I have the right to enter into this Agreement and the right to grant the rights granted hereunder. I agree that the invalidity or unenforceability of any part of this release shall in no way affect the validity or enforceability of any of the remainder of this release. This release constitutes the entire agreement and understanding between me and Producer concerning the subject matter hereof, and supersedes and replaces all prior negotiations, proposed agreements and agreements, written and oral, relating thereto. This release and the rights hereunder may be freely assigned by Producer. My appearance in and in connection with the Program is as a non-performer only, and is not employment, and does not entitle me to wages, salary or other compensation. In no event shall I be entitled to enjoin, seek to enjoin, or otherwise inhibit the production, distribution or exhibition of the Program.
Please sign and print your legal name below *