1) You must be at least 21 years of age.
2) You must be a legal US resident.
3) You must not be a candidate for public office and must agree not to become one until after one (1) year after the initial broadcast of the episodes of the Program in which you appear, if selected as a participant.
4) You may not participate in the Program if your participation would create impropriety or the appearance of impropriety. In making this determination, 495 Productions, Inc. (“Producer”) and NBC Universal, Inc. (“NBCU”) will consider whether you or any member of your immediate family or anyone living in your household is or has been within the last two (2) years an employee, officer, director or agent of any of the following:
(a) NBCU or any television production company, network, station or distributor owned and operated by NBCU;
(b) Producer, or any other person or entity any person or entity involved in the development, production, distribution or other exploitation of the reality-based program currently entitled “Dance Your Ass Off” (the “Program”) or any variation thereof;
(c) Any sponsor of the Program or its advertising agency; or
(d) Any person or entity supplying prizes or other services to the Program.
Please disclose any such employment or association here (if none, say “None”): ________________________________________________________________________________________________________________________________________________
In addition, Producer and NBCU reserve the right to render ineligible any person whom any of them determines, in their sole discretion, is sufficiently connected with the production, administration, judging, or distribution of the Program, such that his or her participation in the Program could create the appearance of impropriety.
5) If selected as a participant, you must execute waivers and release agreements required by Producer and NBCU or any of their licensees, successors or assigns.
6) You will need to be available to the production as requested by Producer and you will be willing to travel to various locations as part of production.
7) Any offer to become a participant is conditioned upon your submission to physical and psychological examinations to be conducted in Los Angeles, CA, by medical professionals selected by and paid for by the Producer and the certification of the medical professionals that you meet all physical and psychological requirements. You must be willing to submit medical information to the production, and you must be willing to submit to a medical examination, psychological examination, and background check.
8) You hereby give the following representations, warranties, acknowledgements, consents and releases:
(a) By signing below, I hereby represent, warrant, acknowledge, and agree that: (i) I have read and I meet and agree to be bound by the eligibility requirements set forth herein; (ii) I have completed this application honestly and accurately; (iii) if any of the information in this application is found to be false or incomplete, this will be grounds for dismissal from the Program participant selection process, and/or from the Program contest (if any), if selected; (iv) even if I meet the eligibility requirements, Producer has no obligation to interview me, and/or select me as a participant; (v) even if I am selected as a participant, Producer has no obligation to conduct the Program contest (if any) or to produce the Program and NBCU has no obligation to broadcast it, even if produced; (vi) all decisions by Producer concerning selection of the participants are final and not subject to challenge or appeal; and (vii) Producer has no obligation to return any materials submitted by me as part of the application whether or not I am selected as a participant.
(b) By submitting this application, I hereby consent to the recording, use and reuse by Producer, NBCU, and any of their respective licensees, successors, assignees, parents, subsidiaries, or affiliated entities, and each of their respective employees, agents, representative, officers and directors (collectively “Releasees”) of my voice, actions, likeness, name, appearance, biographical material, and any information contained in, derived from or obtained in connection with my application to be a participant in the Program or in any materials submitted by me in connection with my application (collectively “Likeness”), as edited, altered, or modified by the Producer or by any of the other Releasees, in any and all media now known or hereafter devised, worldwide in perpetuity, in or in connection with the Program or any other work. I agree that the Releasees or any of them may use all or any part of my Likeness, and may alter or modify it regardless of whether or not I am recognizable. I further agree that the Releasees exclusively own all right, title, and interest (including, without limitation, all copyrights) in and to any and all recordings made by them and in and to any and all video that I have provided in connection with my application and any other materials that I have provided or may provide in connection with my application or the Program (collectively, the “Materials”), including, without limitation, the right to edit, alter or modify the Materials and to use all or part of the Materials and my Likeness in any and all media now known or hereafter devised worldwide, in perpetuity. Without in any way limiting the foregoing, if I perform or include any music (other than music supplied to me by Producer) in connection with my application or the Program, I represent and warrant that I own all rights to such music, and I grant Producer the right to record, reproduce and publicly perform any such music in and in connection with the Program or any other work. Without in any way limiting the waivers and releases set forth herein, I waive any claims to royalties of any kind, whether accruing now or in the future, from Producer and NBCU for the use of any such music, including, without limitation, any applicable copyright, public performance, mechanical and synchronization royalties. I further agree that Releasees may use my Likeness and the Materials in connection with any promotion, publicity, marketing or advertisement. I grant the rights hereunder whether or not I am selected to participate in the Program in any manner whatsoever. I understand that I will not be paid any money for giving Releasees these rights or for signing this agreement.
(c) I hereby authorize Producer and any person or entity designated by Producer to investigate, access and collect information about me, about any of the statements made by me in my application, this Agreement, any supporting documents and any other documents that I have signed or provided or do sign or provide in connection with my application to be selected as a participant in the Program, or any other written or oral statements I make in connection therewith. I irrevocably authorize Producer and any person or entity designated by Producer to secure information about me and my experiences from my current and former employers, associates, friends, family members, educational institutions, government agencies, credit reporting agencies, and any references I have provided, and I irrevocably authorize such parties to provide information concerning me. I hereby unconditionally and irrevocably release and forever discharge Producer, the persons or entities designated by Producer, and all such parties and persons from any and all liabilities arising out of or in connection with any such investigation. I specifically authorize investigation of my employment records, medical records, and government records, including but not limited to my motor vehicle records, criminal records and credit and/or consumer report(s). I acknowledge and agree that any such information obtained by Producer or by any person or entity designated by Producer pursuant to this paragraph or otherwise may be used for purposes of selecting participants in the Program, and may be described or otherwise related in and in connection with the Program.
(d) I hereby authorize Producer and any person or entity designated by Producer to conduct psychological and physical examinations of me as required by Producer. I further authorize the individuals conducting such examinations of me to disclose to Producer and their representatives all information about me obtained in connection with such examinations, and authorize Producer to utilize such information in selecting participants for the Program.
9. RELEASE AND AGREEMENT NOT TO SUE. To the maximum extent permitted by law, I release Releasees from any and all liability arising out of the recording or use of my Likeness and/or the Materials. Further, to the maximum extent permitted by law, I agree not to sue Releasees as a result of the recording or use of my Likeness and/or the Materials (including, without limitation, any claim that such use defames me or invades any right of privacy and/or publicity).
10. As used herein, “Producer” shall include 495 Productions, Inc., its licensees, successors, and assigns, and each of their respective officers, directors, shareholders, employees, agents, and representatives. I agree that Producer may license, assign, and otherwise transfer this application and all rights granted by me under this application to any person or entity.
I have read, understand, and agree with the foregoing.