Love Connection

Have you already spoken with someone from the casting team? If yes, please write their name? *

First Name *

Last Name *

Height *

Age (DOB) *

Phone *

Email *

Hometown (City & State) *

Current State *

Current City *

Occupation *

What is your highest level of education? *

Degree(s) *

Have you ever appeared on a TV show before? Please list name of show and date aired. *

School(s) Attended *

Have you ever been married or engaged? *

Do you have any children? If yes, please list names and ages. *

How would you describe your current dating situation (how often do you go on dates, how is the dating scene in your area, etc.)? *

Have you ever participated in online dating? Please explain. *

Do you have any dating "deal breakers"? Please explain. *

If you were planning the perfect local date on a $500 budget, what would it include? Please describe in detail. *

What's the craziest or funniest date you've ever been on and why? *

What's the worst date you've been on and why? *

What's the most over-the-top thing you've ever done to impress a date? *

Please describe your ideal mate in regards to physical features and personality. *

Do you have any automatic turn-ons and/or turn-offs? *

Is there someone in your life that you ask for approval on someone you date (i.e. your mother, best friend, grandparent, etc.)? *

What has been lacking in your prior relationships that you are hoping to find in your next relationship? *

How many serious relationships have you been in and how long were they? *

How long have you been single? *

What's the worst way you've ever broken up with someone? *

What would your friends say are your best and worst qualities? *

What's one thing we wouldn't know by looking at you? *

What are your hobbies and interests? *

Explain the most life-changing event you've been through: *

What are you hoping to achieve by meeting someone on this show? *

Why are you still single? *

List 3 things about you that would surprise us. *

How would your friends describe you honestly? *

Finish this sentence: I'm the guy/girl who... *

What are your greatest fears? *

What is your life motto? *

What is the craziest thing that has ever happened to you? *

What do you stand for? What do you consider important? *

How did you hear about this casting opportunity? Please be as specific as possible. *

Instagram URL *

Facebook URL *

Please upload a recent photo that we can use as your profile picture. *

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PLEASE READ, SIGN AND DATE the following. CHS 34 PRODUCTIONS INC. PROGRAM APPEARANCE RELEASE “LOVE CONNECTION” 1. Grant of Rights: For good and valuable consideration, receipt and sufficiency of which are hereby acknowledged, I irrevocably grant to CHS 34 Productions Inc. (“PRODUCER”) and its owners, principals, agents, licensees, affiliated and related companies and assigns, the following rights (hereinafter "Rights and Materials"): to interview me (on and off-camera), to record on film, tape or otherwise use the following: my name, likeness, image and/or voice; my on and off camera interview(s), story(ies), activities and performance(s) (hereinafter “Taped Activities”); and other material or information provided by me (including, but not limited to, any video, stills, depictions and/or applications or other materials submitted by me, of which I hereby represent and warrant myself to be the sole copyright owner); my biographical material; and my surroundings (to the extent such occurs in my home or a place of which I have possession). I hereby represent and warrant that I am the sole copyright owner of all such Rights and Materials. I acknowledge and further agree that PRODUCER has the perpetual, irrevocable and unencumbered right (but not the obligation) to use, distribute and exhibit (and/or to authorize others to use, distribute and exhibit) all or part of the Rights and Materials in any and all media now known or hereafter discovered, in perpetuity, throughout the world, including without limitation, in and in connection with segments of the television program currently known by its title “LOVE CONNECTION” (or any related series or version thereof) (the "Program") or in any other program, (and in connection with all ancillary, incidental and subsidiary rights related thereto ), and in television, radio, and other advertisements and promotions for the Program (the "Advertisements") and other programs; and to edit the Rights and Materials, and the Program as PRODUCER wishes. I also understand and agree that PRODUCER may assign this agreement in whole or part and the rights granted herein shall inure to the benefit of PRODUCER, its licensees, successors, and agents. 2. Release: I hereby agree not to sue and irrevocably and unconditionally release, and forever discharge RELEASEES, its past, present and future parents, subsidiaries (whether or not wholly-owned), affiliates, divisions, agents, representatives, employees, successors and assigns, jointly and individually from any and all manner of liabilities, claims and demands of any kind or nature, whatsoever, in law or equity, whether known or unknown, which I (or my assigns, agents and/or representatives) ever had, now have, or in the future may have against the RELEASEES, including, but not limited to claims arising out of or related to the uses described herein, the Program, the Rights and Materials, my decision to participate in the Program, my appearance and participation in the Program, including without limitation, any claims, demands and causes of action for personal injury, invasion of privacy, false light privacy or violation of the right of publicity, defamation, infliction of emotional distress and any other tort in connection therewith (including, without limitation, any claims relating to or arising from any travel by me hereunder) and any costs and expenses (including, without limitation, attorneys’ fees, court costs, settlement and disbursements). I further agree that I shall be liable for any attorneys’ fees and costs incurred by PRODUCER in connection with any claim or lawsuit brought in violation of this agreement. I hereby agree to never sue RELEASEES 1) because RELEASEES did not take or use the Rights and Materials given by me; or 2) because I do not like the manner in which they took or used the rights granted herein by me; or 3) in connection with any claim related to my application for, participation in or exhibition or other exploitation of the Program. I understand and agree that the program may involve the element of surprise. I acknowledge and agree that I have been informed and understand that my appearance, depiction and/or portrayal in the Program may be disparaging, defamatory, embarrassing or of an otherwise unfavorable nature which may expose me to public ridicule, humiliation, or condemnation and, being so informed, I voluntarily agree to appear in the program. 3. Use of Rights/No Revocation: I understand that PRODUCER is not obligated to use any of the rights granted herein. I know PRODUCER will incur expenses in reliance on this Agreement, so I will not revoke it. 4. Entire Release: In signing this Release, I have not relied on any representations or other statements that are not contained herein. No promises have been made to me other than as set forth herein. I understand and agree that no oral agreements are binding. This Release sets forth the entire agreement between me and PRODUCER with respect to the subject matter hereof and may not be altered or amended except in writing signed by both parties. 5. Other: I agree that PRODUCER exclusively owns all right, title, and interest (including, without limitation, all copyrights) in and to the Rights and Materials, and excerpts there from, in connection with the Program including, without limitation, the right to edit, alter and/or modify the Rights and Materials and to use all or part of the Materials and my Likeness forever and throughout the world, and to license others to use them, in any manner in any and all media now known or hereafter discovered or developed, worldwide in perpetuity Materials and PRODUCER has complete and sole discretion as to their use. I represent and warrant that I have the full right, power and authority to grant the rights herein granted. Under penalties of perjury, I certify that the information, materials and representations given or made by me which are contained on this form are true and correct. In no event shall I have a right to enjoin the development, production or distribution or exploitation of the Program. I also understand and agree that PRODUCER may transfer and assign this agreement in whole or in part to any entity or individual without restriction and the rights granted herein shall inure to the benefit of PRODUCER, its licensees, successors, and agents. This Release shall be binding on all of my successors-in-interest and heirs. This Release shall be governed by the laws of the State of California. The parties hereto agree to submit to jurisdiction in the State of California. 6. I understand that it is a federal offense and, therefore, I agree not to give anyone associated in any manner with the Program anything of value for arranging my appearance in the Program, or to accept or agree to accept anything of value to promote any product, service or venture in said Program, or to use any material containing such a promotion where I know the preparer of the material received consideration for its inclusion. 7. I represent and warrant that all information I am providing to PRODUCER on this release is valid, true and accurate, and that I have (or will concurrently provide) to PRODUCER a legible photocopy of my valid driver’s license, passport or other acceptable government-issued photo identification for PRODUCER’s verification and record-keeping purposes. I HAVE BEEN GIVEN AMPLE OPPORTUNITY TO READ, AND I HAVE CAREFULLY READ, THIS ENTIRE AUTHORIZATION AND RELEASE. I FULLY UNDERSTAND THE CONTENTS OF THIS AUTHORIZATION AND RELEASE, I AM OF SOUND MIND AND I INTEND TO BE LEGALLY BOUND BY THIS AUTHORIZATION AND RELEASE. I AM AWARE THAT THIS AUTHORIZATION AND RELEASE IS, AMONG OTHER THINGS, A RELEASE OF LIABILITY FOR FUTURE INJURIES AND A CONTRACT BETWEEN MYSELF AND PRODUCER AND THAT I AM SIGNING THIS AUTHORIZATION AND RELEASE OF MY OWN FREE WILL. THE PROVISIONS HEREOF SHALL BE BINDING UPON ME AND MY HEIRS, EXECUTORS, ADMINISTRATORS AND SUCCESSORS.

I represent and warrant that I am at least 21 years of age and have the right to enter into this Agreement. I have read and understood the Agreement, and I understand that by filling in my name below, I agree to be legally bound to the terms of this Agreement.

ELIGIBILITY REQUIREMENTS *

By checking the box I confirm that I agree to the Terms of Use and Privacy Policy for this website, and I represent and warrant that I meet the Eligibility Requirements and Casting Terms listed below. ELIGIBILITY REQUIREMENTS: I hereby represent and warrant as follows: (a) That the name given below is my legal name and I am 18 years old or older and am not, nor do I intend to be within the following year, a candidate for public office. I am a legal resident of the United States. I acknowledge that I have not been convicted of a felony. I have not had any restraining orders or other injunctive relief against me, and I have a valid, unrestricted driver’s license. (b) I am currently single, specifically meaning I am not currently in a marital relationship (of any nature), nor a cohabitation relationship involving physical intimacy or a monogamous dating relationship of more than two (2) months in duration. (c) I am not, nor is any member of my immediate family (parents, siblings, children) employed by, or have been employed by within the last two (2) years, the following groups: Time Warner Entertainment Co., L.P., Next Entertainment, Inc., CHS 34 Productions Inc., Fox Broadcasting Companies (the “Network”), the Producer(s) of the Series, known major sponsors of the Series or their advertising agencies, trade-out partners, product integration partners, any station initially airing the Series, any entity associated or affiliated with the Executive Producers of the Series and/or their respective parents, affiliated companies, officers, directors, agents, representatives, licensees, partners, employees and assigns. If at any time I become aware of, or I am introduced to or meet, any officer, employee, independent contractor, agent, or representative or any of 1 (c ) above, I shall promptly notify Producer in writing of same and provide the names of such persons and their affiliation. I acknowledge and agree that, without limiting Producer’s discretion to disqualify, reject, or render me ineligible for any reason, Producer and Network have the sole discretion to render ineligible any person who, in Producer’s and Network’s sole discretion, is sufficiently connected with the production, administration, judging, exploitation or distribution of the Series (including, without limitation, episodes of the Series and the advertising, promotion, marketing, publicity, merchandising and ancillary exploitation thereof) in a manner such that his or her participation in the Series could create the appearance of impropriety. Conversely, Producer and Network reserve the right to allow any person to remain part of the Series who may be acquainted with a person or entity connected with the production, administration, casting or distribution of the Series if, in Producer’s and Network’s sole discretion, Producer and Network determine that such person’s involvement in the Series does not and will not affect the integrity of the Series. Such decisions shall be final and are not subject to challenge or appeal. (d) I have not within the past year appeared in any unscripted/reality/game television show series, including but not limited to, “Survivor”, “Big Brother”, “The Voice” etc. I have disclosed to CHS all instances of my appearance on television, no matter when occurring. I have not applied for (or if I have applied, I have withdrawn such application prior to submitting this one) nor am I involved in the current production of any such television show.

I represent and warrant that I am at least 21 years of age and have the right to enter into this Agreement. I have read and understood the Agreement, and I understand that by filling in my name below, I agree to be legally bound to the terms of this Agreement.

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