Untitled Relationship Project
PLEASE ANSWER EVERY QUESTION BELOW
Date of Birth (for verification purposes only pursuant to 18 U.S.C. §§ 2256 et seq)
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
What is the best way and time to reach you?
Do you have a website or Facebook? Twitter? Please list addresses
How did you hear about the show?
Name of Partner for show
Date of Partner's Birth (for verification purposes only pursuant to 18 U.S.C. §§ 2256 et seq)
Are you authorized to work in the United States?
Have you been on other reality shows? If so please list title of show, network and dates aired
Have you ever been convicted of a felony?
If yes, please explain
Tell us how you met your partner. What was your first impression of her/him?
How long have you and your partner been dating?
Do you live together?
Describe your personalities / dynamic as a couple. Why does it work?
What common interests / hobbies do you two share?
Was there a moment you knew that you wanted to spend the rest of your life with her/him? Please describe
If picked for the show, how would you like to propose? Why? (List as many different ideas / options as you can)
Please list the name(s) and contact info of confidents or partners in crime that would be willing to help you pull off your proposal idea
Why do you want to be on the show?
What makes your proposal idea so special?
Please upload a recent picture of yourself
Please upload a recent picture of your partner
One more of you two together (if you have one)
I hereby acknowledge that I have read and I meet the eligibility requirements. I hereby certify that all statements made in this application are true and complete. I understand that if any of the disclosures made by me on this application are false, this will be cause for disqualification of my consideration for this production.
I further acknowledge and accept that this application form and any other materials (including, but not limited to, photographs, and videotapes) I have submitted or will submit to Cornwell Casting Inc. will become the sole and exclusive property of Cornwell Casting Inc. and will not be returned to me. I understand that as the owners of this material Cornwell Casting Inc..shall have the right to edit, distribute and exploit the material submitted in any manner in their sole discretion but shall have no obligation to do so. By signing below, I grant to Cornwell Casting Inc. the right to use any biographical information contained in this application, my home video or taped interview, and to record, use, and publicize my home videotape or taped interview, voice, actions, likeness and appearance in any manner in connection with this production.
I hereby release and indemnify Cornwell Casting Inc. and all of their respective licensees, assigns, successors, parents, affiliated and subsidiary companies, divisions, and joint ventures as well as their employees, officers, directors and agents (collectively, the “Released Parties”) from any and all claims or demands of every kind that I or any third party may now or hereafter have against the Released Parties in connection with my application to appear in the production and the exploitation of any and all materials I have submitted in connection therewith, or any exercise by any or all of the Released Parties of any of the rights I am granting hereunder, or any other matter contained herein, including, but not limited to, any claims for defamation, violation of rights of privacy and/or publicity, negligence, and/or intentional infliction of emotional distress.
In connection with the foregoing releases, I hereby expressly waive any and all rights and benefits conferred by the provisions of Section 1542 of the California Civil Code or by any similar law or provision of any jurisdiction throughout the world. Section 1542 reads as follows: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE WHICH, IF KNOWN BY HIM, MUST HAVE MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR.”
BY CHECKING THE "I AGREE TO THE TERMS ABOVE" BOX BELOW AND FILLING IN YOUR FIRST AND LAST NAME YOU AGREE TO THE TERMS WITHIN THE ELIGIBILITY REQUIREMENTS AND RELEASES ABOVE
I DON'T AGREE
Do Not Fill This Out