CONTESTANT AGREEMENT AND RELEASE
“WIPEOUT CANADA”
NOTE: DO NOT SIGN THIS UNTIL YOU HAVE READ IT COMPLETELY AND ENSURE
THAT IT IS FULLY COMPLETED PRIOR TO SUBMISSION TO PRODUCER
[To be filled in by applicant]
Dated
1817141 Ontario Inc.
72 Stafford St., Suite 400
Toronto, Ontario
M6J 2R9
Ladies and Gentlemen:
I have completed and submitted the “Wipeout” application (the “Application”) to be
considered by 1817141 Ontario Inc. (“Producer”) to become a contestant in the television series
currently entitled “Wipeout Canada” (the “Series”), which is being co-produced by Producer and
Endemol Argentina S.A. (“Endemol”) and is currently scheduled to be initially broadcast on one or more
television networks owned or controlled by Canwest Television Limited Partnership (the “Network”). I
understand that Producer is selecting finalists to become contestants, and may conduct one or more
interviews with me (the “Finalist Interview”) for that purpose.
I have volunteered to participate as a contestant on the Series and I acknowledge and agree
that my sole compensation for my participation as a contestant, if any, will be my winnings (cash
and/or prizes) earned on the Series. I understand that Producer is merely considering me as a
contestant on the Series and that Producer has no obligation to allow me to participate as a
contestant.
I am making the representations, warranties, disclosures, and covenants and agreements set
forth in this Contestant Agreement and Release (the “Agreement”) so that Producer will continue to
consider me to become a contestant in the Series. If any disclosure or representation is false, misleading
or incomplete, or if I breach this Agreement or any other agreement that I have made or may make in the
future in connection with the Series, Producer may remove me from consideration as a contestant in the
Series, remove me from the Series, and/or may withhold from me any Prize (as defined herein) or monies
that I would otherwise have won; and I shall return to Producer any Prize or monies already delivered to
me. In that event, Producer and the Network, in their sole discretion, may make any explanation or
announcement, on-air or otherwise.
I UNDERSTAND THIS IS AN IMPORTANT LEGAL DOCUMENT RELATING TO
MY POTENTIAL PARTICIPATION IN THE SERIES, AND BY SIGNING THIS DOCUMENT I
AM WAIVING LEGAL RIGHTS I MAY HAVE AGAINST PRODUCER, THE NETWORK,
BROADCASTERS, SPONSORS OF THE SERIES AND OTHERS.
DISCLOSURES, ACKNOWLEDGEMENTS AND ASSUMPTION OF RISK
1.
I have voluntarily applied to participate in the Series to engage in various
activities in one or more locations to be designated by Producer in its sole discretion. I understand that the
Series is a competition program where contestants attempt to successfully negotiate a series of challenges
with only one contestant being determined the winner in each episode of the Series. I agree to follow all
of Producer’s directions and instructions in all matters. Any actual or alleged consequences of my
following such directions and instructions shall be included within the matters released and indemnified
pursuant to this Agreement. I understand that my participation in the Series may involve, but not be
limited to, traveling by air, train, and/or automobile, as well as strenuous and/or dangerous physical
and/or mental activity, including, without limitation, racing, climbing, swimming and other water-based
activities, performing obstacle courses, and engaging in other competitive physical challenges, with
which I may or may not have had any prior familiarity and/or experience. I acknowledge that I have
freely and knowingly consented to participating in such situations and activities and other similar
activities. I represent that I believe myself to be in excellent physical, emotional, psychological and
mental health, and am physically and mentally capable of performing any such activities or other similar
activities. I represent and warrant that I am an experienced swimmer and able to hold my breath under
water. I understand that I am solely responsible for determining whether I am physically, emotionally,
psychologically and mentally able to participate in the Series. I acknowledge and understand that, as with
participating in other hazardous activities, my participation in the Series carries with it the potential for
death, serious physical injury, extreme emotional distress, mental or physical illness and property loss.
The waivers, releases, and indemnities in this Agreement and any other agreement that I have executed or
that I may execute in connection with the Series expressly apply to my participation in any such situations
and activities.
2.
If I am selected to participate, I understand that my participation in the Series
may expose me and other contestants to a variety of conditions that may cause me serious bodily injury,
illness or death, including but not limited to: physical stunts which may result in collision with objects,
people and equipment; equipment failure or defect; falls from heights, objects and equipment into water;
water hazards, including but not limited to, drowning and exposure to water-borne contaminates; physical
contact with and exposure to other contestants, spectators and others; loss of orientation; exhaustion,
dehydration, fatigue, and overexertion. I understand and acknowledge that while conduct giving rise to
such situations and activities might in limited circumstances give rise to an action in tort or contract, I
have freely and knowingly consented to such conduct and to participating in such situations and activities.
3.
I understand that Producer, directly and/or through independent contractors, will
provide various services and equipment in connection with the Series and its contestants. These services
and equipment may include, but are not limited to, preparation for the Series; transportation to, from and
about the sites of the Series (whether via air, train, automobile or otherwise); provision of food and/or
water; furnishing equipment (including, without limitation, protective body and head gear and other
safety equipment); the supervision of certain other activities; emergency equipment and services; and
medical and first aid services. I acknowledge that neither Producer nor any contractor or employee
providing equipment or services in connection with the Series has made any warranties whatsoever with
respect to equipment or services furnished by them in connection with the Series or otherwise used by any
contestants, and that there are no warranties of any kind from anyone regarding the equipment’s fitness or
services or suitability for use for any purpose in connection with the Series, including, without limitation,
that in the event any safety equipment and/or protective body and head gear is provided to me, that such
articles, individually, or collectively, are adequate to protect me from any injuries and/or death. I hereby
waive any right I might otherwise have to warnings or instructions regarding any aspect of the Series or
the equipment or services utilized in connection therewith. Without in any way limiting the foregoing, I
acknowledge and agree that any medical procedures, if any, offered to me in connection with my
participation in the Series may involve calculated risks of complications, infection, disfigurement, injury
or even death, from both known and unknown causes, and no warranty or guarantee has been made as to
the result of such procedures, and I assume all risks with respect thereto. I also acknowledge and agree
that no warranty, representation or guarantee has been made as to the qualifications or credentials of the
medical professionals performing such procedures, or their ability to diagnose medical conditions that
may affect my fitness to participate in the Series. I acknowledge and agree that, should I undergo any
medical treatment or procedures by any medical professional whether or not provided by Producer,
Producer is not responsible for any costs or claims in connection with or arising from such treatment or
procedures.
4.
I acknowledge that the foregoing is not an exhaustive list of the risks, hazards
and dangers I may be exposed to as a result of the Series activities, and I voluntarily and freely accept and
assume these and all such other risks, hazards and dangers inherent or otherwise which I may encounter
or be exposed to and understand and acknowledge that the waivers, releases and indemnities in this
Agreement expressly apply to these risks, hazards and dangers.
5.
I recognize that participating in the Series necessarily will involve strenuous and
dangerous physical activities, including, without limitation, some or all of those described in this
Agreement. I understand that some or all of these activities are not recommended during pregnancy. I
represent and warrant that if I am pregnant or if I become pregnant during my participation in the Series, I
shall notify Producer immediately and shall remove myself from the competition.
GRANT OF RIGHTS
6.
I irrevocably grant to Producer the right (a) to interview me, as many times and
for such periods of time as Producer requests in its sole discretion, and to videotape, film and otherwise
record such interview(s) and my statements and appearances therein, including my name, voice and
likeness (including, without limitation, during the contestant selection process), and (b) if I am selected by
Producer to be a contestant in the Series, to videotape, film, portray, photograph and otherwise record me
and my actions and record my voice and other sound effects in connection with the production of the
Series. Any such interview(s), any and all information I have supplied or may supply in such
interview(s), in the Application or otherwise (including biographical information, photographs and
videotapes of me and/or others, and any other materials), any and all other information Producer has
received or will receive from other sources, my appearance, actions, voice and sound effects in
connection with the Series (including, without limitation, any act, poses, plays, vocal, instrumental,
musical and other sound effects, and compositions of any kind or nature), and the results and proceeds of
my participation in the Series, and any reproductions or recordings of any nature of any of the foregoing,
in whole or in part, shall be referred to as the “Material.” The Material shall also include, without
limitation, any and all material that I may create or participate in the creation of in connection with the
Series, including, without limitation, any personal journals or diaries (including, but not limited to, video
diaries, vlogs, and blogs) I may write or to which I may contribute, and any photographs and video and
sound recordings taken by me during my participation in the Series. The Material, including the
copyright(s) and all other rights therein (and all renewals and extensions thereof), shall be the sole and
exclusive property of Producer, and in consideration of Producer’s considering me to be a contestant on
the Series, and for other good and valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, I hereby grant and assign to Producer all rights of any nature in and to the Material. The
Material may be used, broadcast, exhibited, distributed, advertised, publicized, promoted or otherwise
exploited by such means and for such purposes (including without limitation merchandising, and
commercial and non-commercial publishing) and in any and all media, now known or hereafter devised
(including without limitation television [whether free, pay, cable, satellite or otherwise], theatrical, nontheatrical, cassettes, discs and other home video devices, radio, the Internet, mobile, wireless and other on
line or computer-assisted media, and print media) as Producer designates, throughout the universe, in
perpetuity, at any time and from time to time, whether as part of the Series (including, without limitation,
any broadcast season of the Series, regardless of the broadcast season for which I was originally
considered and/or selected as a contestant), or otherwise. The Material may be edited, cut, rearranged,
adapted, dubbed or otherwise revised or modified for any such purposes by Producer in its sole discretion,
and I waive the exercise of any “moral rights” and “droit moral” and any analogous rights however
denominated in any jurisdiction of the world. Producer will own any so called “rental and lending rights”
or similar rights. I hereby grant to Producer the perpetual and worldwide right to use my name, sobriquet,
likeness (actual or simulated), photograph, caricature, voice and biographical material in and in
connection with the development, production, exhibition, advertising, publicity, promotion,
merchandising and other exploitation of the Material, whether as part of the Series, or otherwise by
Producer, the Network, Endemol, any of their assignees or licensees, or any of their respective affiliated
and related companies, and in advertising and promotion for any Sponsor of any of the foregoing, or
otherwise, or in connection with the exploitation of any subsidiary and ancillary rights therein, or in
connection with Producer’s business activities and the business activities of the networks, stations,
sponsors, and other users, exhibitors, assignees and licensees of the Material and/or the Series for any
purpose including, without limitation, for any commercial purpose whatsoever, including, but not limited
to, product endorsement, related to the Series. I agree that any broadcast, telecast or other exploitation of
the Material or any rights therein, whether as part of the Series or otherwise, will not entitle me to receive
any prize or compensation. Without in any way limiting the foregoing, I acknowledge and agree that the
Network shall have the right to use the Materials, any part or element of the Materials, my name,
sobriquet, likeness (actual or simulated), photograph, caricature, voice and biographical material in and in
connection with advertisements, promotions and publicity for the Series, for the Network, and for any
stations and other persons and entities broadcasting, telecasting or otherwise exhibiting the Series.
Without limiting the foregoing, such rights shall also extend beyond the initial episode my Materials may
appear in and could include a “best of” compilation episode or episodes and any internet use as
determined by Producer in their sole discretion.
PARTICIPATION
7.
I understand that Producer may select me to be a contestant in the Series for any
broadcast season of the Series, whether or not the broadcast season for which Producer selects me is the
same broadcast season for which I originally submitted the Application (e.g., even if Producer does not
select me to be a contestant for the current broadcast season of the Series, Producer may still select me for
any subsequent broadcast season of the Series, and the terms of this Agreement shall continue to apply).
If I am selected by Producer to be a contestant in the Series, I agree to participate as a contestant in
connection with the production of the Series as and to the extent required by Producer or the Network on
such dates and at such locations as Producer or the Network shall designate in its sole discretion, and
which dates and locations Producer or the Network may change in its sole discretion. I further agree, for
the period commencing with the effective date of this Agreement and continuing through and including
one (1) year after the initial broadcast of the last episode of the Series in which I appear (the “Exclusive
Period”), to be available and to participate in additional taping (including, without limitation, voice
overs) as and where Producer or the Network may require in connection with the Series, publicity,
interviews and similar matters (e.g., to appear on news shows, talk shows, other programs, institutional
advertising and promotions for Producer and/or Network and to make other appearances as required by
Producer or the Network) as and when designated by Producer or the Network in its sole discretion
(whether before, during or after production of the Series). During the Exclusive Period, I agree to abide
by all directions, guidelines and restrictions that may be provided to me from time to time by Producer
and/or Network in connection with the promotion, marketing, advertising and publicity of the show.
8.
I further agree that, during the Exclusive Period, I shall not grant any interviews
to any third parties, nor shall I appear on or authorize production of or participate in any way with any
other television programming, commercials or advertisements, radio programming, or in any print media,
Internet/on-line services, or any other media outlet, now known or hereafter devised, without Producer
and the Network’s prior written approval.
9.
Without limiting the generality of my participation as set forth hereinabove, I
agree that if I am selected as a contestant, I shall participate in any other activities that Producer may
request, including, without limitation, participating in screen tests and videotaped interviews at my home
and at Producer’s request, I shall use my best efforts to have my family members, co-workers and friends
participate in such interviews (the recordings of such interviews being part of the Material referred to in
Paragraph 6 hereinabove) and any other matters as Producer may designate in its sole discretion.
10.
I acknowledge that Producer will provide me with the competition rules for the
Series (“Series Rules”) and that I will read the Series Rules. I hereby agree to follow and obey the Series
Rules (as they may be changed, modified or amended by Producer in its sole discretion from time to time,
at any time) and acknowledge that, if selected as a contestant, my participation on the Series will signify
my clear understanding of the Series Rules. I understand that each competitive challenge that comprises
the Series (each, a “Challenge”) may have additional rules (“Challenge Rules”), which I agree to follow
and obey. I acknowledge that, if selected as a contestant, my participation in a Challenge will signify my
clear understanding of the Challenge Rules therefor. I understand that failure to comply with any Series
Rule and/or Challenge Rule may result in my immediate disqualification and/or elimination from any
contest or the Series in Producer’s sole discretion, and the forfeiture of any prize. The waivers, releases,
and indemnities set forth in this Agreement and any other agreement that I have executed or that I may
execute in connection with the Series expressly apply to any such disqualification or failure to qualify. I
shall immediately report to the Executive Producer any violations of such rules by any other contestants.
I agree to cooperate with and to follow all of Producer’s directions and instructions in all matters.
Producer’s decisions on all matters (including contestant selection and decisions regarding the creation
and implementation of terms, conditions and rules governing the Series) shall be within Producer’s sole
control and shall be final and binding on me in all respects and shall not be subject to challenge or appeal.
In addition, if any activity on the Series is halted for any reason, I shall abide by Producer’s decision
regarding the resumption of the activity and disposition of any Prize. I understand that Producer reserves
the right, in its sole discretion and at any time, to change, add, delete from, modify or amend the terms,
conditions and rules affecting the conduct of the contestants on the Series, the Series activities, the
elimination of contestants from the Series and the granting or withholding of any Prize, and I agree to be
bound by the terms, conditions and rules as modified by Producer.
11.
Without in any way limiting anything contained in the Series Rules, I understand
that if I am selected as a contestant, I will participate in Challenges requiring a high degree of athletic
skills and abilities testing my physical, mental and emotional strength and ability. I understand and
acknowledge that other contestants may possess a different level of athletic skill and ability than me and
that certain Challenges may involve athletic skills and abilities that put me at a competitive disadvantage
with respect to that particular Challenge. I acknowledge that such varying levels of athletic skills and
abilities will necessarily be a part of the contest, and any matters relating to any such competitive
disadvantage shall be included within the matters released in this Agreement. I further understand that
the conditions under which I perform a Challenge may be different from the conditions under which
another contestant performs the same Challenge, and acknowledge that such varying conditions will
necessarily be a part of the contest, and any matters relating to such discrepancies shall be included within
the matters released in this Agreement.
12.
I understand that, if I am selected, any contest in which I will participate may, in
Producer’s sole discretion, have a prize or prizes (the “Prize”) – to be awarded according to the Series
Rules and procedures established by Producer in its sole discretion, as such procedures and Series Rules
may be amended and changed by Producer in its sole discretion at any time. The selection of any winner
shall be final and binding and is not subject to any challenge or appeal. The methods of eliminating
contestants from the contest and the Series are as established by Producer, as set forth in the Series Rules
(as such may be changed, modified or amended from time to time in Producer’s sole discretion). If I am
eliminated, the decision to eliminate me shall be final and binding and not subject to challenge or appeal.
Producer may discontinue any Challenge at any time for any reason, even if the Challenge has already
commenced, and even if other contestants have already completed the Challenge. In the event of any
such discontinuation of a Challenge, Producer shall have the right in its sole discretion to determine
whether or not to conduct a replacement Challenge, whether or not any contestants will proceed to the
next Challenge and whether or not to award the Prize or any portion thereof. The Prize may, in
Producer’s sole discretion, be contingent upon the episode of the Series where the winner of such prize is
determined actually being broadcast, and awarded only after such broadcast. Producer may in its sole
discretion furnish contestants with a stipend as an all-inclusive amount to cover the contestants’ expenses
(including meals) while the contestants are participating in the Series at the location of production of the
Series (the “Location”). I acknowledge and agree that I will be responsible for any expenses I incur
outside of the food, travel and accommodations supplied by Producer and that I will be solely responsible
for any costs, charges and expenses resulting to any changes made in travel arrangements for me,
including without limitation dates or times of flights and extended hotel stays. I acknowledge and agree
that, even if I am eliminated from the chance to win the Prize, I may be required by Producer in its sole
discretion to remain at and/or return to the Location at Producer’s expense, and I agree, if so required by
Producer, to make myself available in connection therewith, and to observe and/or participate in any
events as designated by Producer in its sole discretion. I further acknowledge and agree that if I am so
required by Producer and I fail to comply with Producer’s requirements, then I shall forfeit the
opportunity to win the Prize, even if already awarded.
13.
I acknowledge and agree that I may be chosen as an alternate (as opposed to a
contestant) by Producer in its sole discretion. If I am chosen as an alternate, I shall travel to the Locatoin
and remain available to participate in the Series as a contestant if and when chosen by Producer to replace
a contestant. I understand that if I am selected to be an alternate and not chosen to replace a contestant,
then I do not have any chance to win the Prize and no consideration shall be payable to me. I
acknowledge and agree that Producer may, at any time and in its sole discretion, add, remove or replace
contestants. I acknowledge and agree that all the terms and conditions of this Agreement (including,
without limitation, the confidentiality and release provisions set forth herein) shall apply to me with full
force and effect whether I am initially selected as an alternate or a contestant and whether or not I am
ultimately selected as a contestant or to replace a contestant.
14.
I acknowledge and understand that while the film, tape, audio and other
recordings that will be made of me in connection with the Series could otherwise constitute a serious
actionable invasion of my privacy, I have freely and knowingly consented to such conduct. I also
acknowledge that I understand that film, tape, audio, videotape, and other recordings of my actions and
statements, and the actions of the other participants in the Series, may be made using concealed or hidden
cameras, and other devices located throughout the Location, and I expressly agree to any such recordings
made using concealed cameras and other devices. I hereby give my express, unconditional and
irrevocable permission to Producer to fully exploit all materials made using any type of filming or
recording equipment, including without limitation, concealed cameras and other devices, irrespective of
whether my privacy has been or will be invaded by the making or exhibition of such materials and
irrespective of whether such materials violate any other rights I now hold or may hold in the future. (For
the avoidance of doubt, all such materials shall all constitute “Material” as set forth in Paragraph 6
hereinabove.)
15.
I understand that in and in connection with the Series, I may reveal and/or relate,
and other parties (including, without limitation, other contestants, Producer, the on-air interviewers at the
Location and the studio commentators (the “Hosts”) of the Series, and the Network) may reveal and/or
relate information about me of a personal, private, surprising, defamatory, disparaging, embarrassing or
unfavorable nature, and that my actions and the actions of others appearing in the Series may be
embarrassing or of an otherwise unfavorable nature that may be factual or fictional. I further understand
that my appearance, depiction, and/or portrayal in and in connection with the Series, and my actions and
the actions of others displayed in and in connection with the Series, may be disparaging, defamatory,
embarrassing or of an otherwise unfavorable nature, may expose me to public ridicule, humiliation or
condemnation, and may portray me in a false light. I further understand and agree that during my
appearance, Producer, in its sole discretion, may require me to wear clothing, costumes, accessories,
and/or makeup selected by Producer. I further understand that any negative information regarding me
that Producer may disclose during the Series may be more or less favorable than similar information
disclosed by Producer regarding other contestants. I acknowledge and agree that Producer, the Network,
and any television station or channel, cable network, or satellite network that airs the Series, and any of
their licensees, successors and assigns shall have the right (but not the obligation): (a) to include any such
information and any such appearance, depiction, portrayal, actions and statements in the Series as edited
by Producer in its sole discretion, and in any and all advertisements, promotions and publicity for the
Series and for the Network (the “Advertisements”), and (b) to broadcast and otherwise exploit the Series
and the Advertisements containing any such information and any such appearance, depiction, portrayal or
actions (which, for the avoidance of doubt, shall all constitute “Material” as set forth in Paragraph 6
hereinabove). I understand and acknowledge that, while such conduct might otherwise constitute an
actionable tort, I have freely and knowingly consented to such conduct. The waivers, releases and
indemnities in this Agreement and any other agreement that I have executed or that I may execute in
connection with the Series expressly apply to any such inclusion and exploitation.
16.
In connection with my participation in the Series, I shall not infringe upon or
violate the rights of any other person or entity (including without limitation any other contestant). I shall
not cause injury or harm to the person or property of any other person, including, without limitation, any
other contestant, and will abide by all contestant rules of conduct, as well as all applicable Canadian.,
provincial and local laws, rules, regulations, codes and ordinances, and the laws, rules, regulations, codes
and ordinances in effect in any location I visit outside of Canada. I understand that while participating in
the Series, I will be subject to the laws in effect in each of the places I visit. I understand that violating
any such law may result in the imposition of criminal and/or civil penalties for which I will be solely
responsible. I agree to refrain at all times from all forms of violence against and intimidation of other
contestants, of any employees, agents or other representatives of Producer and the Network, and of any
other person; provided, however, that with respect to any Challenge in which I participate, such
prohibition shall not apply to physical contact with and intimidation of other contestants as is customary
in the normal course of athletic competition and otherwise allowed according to the rules for such
Challenge. The waivers, releases, and indemnities in this Agreement and any other agreement that I have
executed or that I may execute in connection with the Series expressly apply to any criminal and civil
penalties that may be imposed on me, and to any disqualification of me by Producer as a result of my
failure to obey the Series Rules (as changed, amended or modified by Producer, in its sole discretion, at
any time or from time to time) or applicable law.
17.
I understand that I may discontinue my participation in the Series and withdraw
as a contestant in the Series at any time and, in particular, I shall always have the right at all times to
refuse to perform any particular Challenge in my sole discretion; provided, however, that no such
discontinuation, withdrawal or refusal will affect any of the rights assigned by me or any of the
covenants, agreements, waivers, releases or indemnities made by me in this Agreement. If I voluntarily
discontinue my participation in the Series, or take any action that would render me ineligible to
participate in the Series, then I shall forfeit any chance to win any prizes or awards. In addition, I
acknowledge and agree that any such discontinuation, and any refusal to perform any particular
Challenge, must occur on camera and will be recorded, and that any Material obtained by Producer prior
to such discontinuation and any Material relating to any such refusal, may be used, broadcast, exhibited,
distributed, advertised, publicized, promoted or otherwise exploited by Producer as part of the Series or
otherwise, as Producer determines in its sole discretion.
18.
I agree to make best efforts not to damage any equipment, wardrobe or other
materials furnished and/or used by Producer in connection with the production of the Series in any way. I
will not tamper with or hinder in any way the technical equipment that is used for purposes of recording
me and the other contestants, or any equipment used by me or other contestants in connection with the
Series.
19.
I will disclose to Producer if any relative, friend or acquaintance of mine appears
in the Series, and I understand that I can be disqualified as a contestant, at Producer’s election and in
Producer’s sole discretion, in such event. I understand that my success or failure in the Series may be
affected by the decisions, actions, and performances of other contestants. The waivers, releases, and
indemnities in this Agreement and any other agreement that I have executed or that I may execute in
connection with the Series expressly apply to any such decision, action, and performance of other
contestants, and to any other action by another contestant or other contestants or any other third party
occurring at any time.
MEDICAL REPORTS, CONSENTS AND AUTHORIZATIONS
20.
I irrevocably authorize Producer to conduct physical and psychological
examinations of me, including, without limitation, drug and steroid testing, in connection with its
selection of contestants for the Series and I acknowledge that Producer has no obligation to actually
conduct such examinations and tests. I agree to sign the authorization attached to hereto as Exhibit A and
incorporated by reference herein, on Producer’s request, will sign any additional medical authorizations
Producer may require. I understand and acknowledge that I am solely responsible for determining
whether I am physically and mentally able to participate in the Series, and that the opinion of medical
personnel contracted by Producer to conduct physical and mental examinations of me regarding my
fitness to participate in the Series is not a substitute for my own judgment or that of my own physician. I
further acknowledge that if any drug and/or steroid test detects the existence of illegal drugs, controlled
substances, and/or steroids in an applicant, such applicant may be disqualified from becoming a
contestant on the Series (and thereby forfeit any chance to win the Prize).
21.
I irrevocably authorize Producer to investigate, access and collect information
about me and any of the statements made by me in the Application, this Agreement, any supporting
documents and any other document that I have signed or do sign in connection with my application to be
selected as a contestant in the Series or my participation in the Series, or any other written or oral
statements I make in connection therewith. I irrevocably authorize Producer to secure information about
my experiences from my current and former employers, associates, family members, educational
institutions, government agencies, credit reporting agencies, and any references I have provided or that
are developed by Producer, and I irrevocably authorize such parties to provide information concerning
me. I hereby unconditionally and irrevocably release and forever discharge all such parties and persons
from any and all claims, actions, damages, liabilities and losses arising out of or in connection with any
such investigation. I specifically authorize investigation of my employment record, medical record, and
government records, including, but not limited to, my motor vehicle records, criminal record, military
record, and credit and/or consumer report(s). I acknowledge and agree that any such information
obtained by Producer pursuant to this paragraph or otherwise may be used for purposes of selecting
contestants in the Series and determining eligibility to win a prize.
22.
I irrevocably authorize Producer, if I am selected to be a contestant in the Series,
to conduct psychological and physical examinations of me, including, without limitation, drug and steroid
testing, on a periodic basis prior to and during the production of the Series as required by Producer and I
acknowledge that Producer has no obligation to actually conduct such examinations and tests. I further
authorize the individuals conducting such examinations of me to disclose to Producer and its
representatives all information about me obtained in connection with such examinations. In addition to
and notwithstanding the foregoing, if selected as a contestant I will supply the Producer, upon request, a
medical certificate, in the form required by Producer, at least 20 days prior to the schedule departure date
for the Location. I acknowledge and agree that Producer may, at any time and in its sole discretion, add,
remove or replace contestants, including if Producer determines in its sole discretion that any contestant is
not mentally or physically fit to continue as a contestant in the Series. I further acknowledge that if any
drug and/or steroid test detects the existence of illegal drugs, controlled substances, and/or steroids in a
contestant, such contestant may be disqualified from the contest and removed from the Series (and
thereby forfeit any chance to win the Prize). I shall notify Producer, immediately upon becoming aware
of such condition and in any case prior to leaving for the Location and prior to participating in the Series,
of any physical, medical or mental condition that might affect me or any other people (including, without
limitation, Producer and other contestants). Any information obtained by Producer hereunder may be
used (a) for evaluation of my application to participate in the Series, (b) for purposes of selecting
contestants in the Series, and (c) for any other purposes designated by Producer in its sole discretion.
Without in any way limiting the foregoing, any such information may be used, broadcast, exhibited,
distributed, advertised, publicized, promoted or otherwise exploited by Producer as part of the Series or
otherwise, as Producer determines in its sole discretion. Furthermore, I understand and agree that any
such information may be disclosed to other contestants in the Series, and may be disclosed on-camera.
23.
In case of an emergency, I authorize Producer to arrange for or provide such
medical assistance to me as it determines necessary. I also authorize any licensed physician, health care
personnel and/or medical facility to provide any medical/surgical care and/or hospitalization of me,
including anesthetics, which such licensed physician, health care personnel and/or medical facility
determines necessary or advisable, pending receipt of a specific consent from me. I authorize any
reasonably necessary care by paramedics. In connection with the foregoing, I also agree to execute a
copy of the Emergency Medical Release attached hereto as Exhibit B and incorporated by reference
herein.
FURTHER DISCLOSURES, COVENANTS, REPRESENTATIONS AND WARRANTIES
24.
I am, or will be, at least nineteen (19) years of age by the date of commencement
of shooting of the episode of the Series in which I am competing.
YES:
25.
currently reside in
(city/province).
NO:
I am a legal resident of the Canada (other than in the Province of Quebec), and I
26.
Neither I nor any member of my immediate family (i.e., spouse, mother, father,
daughter, son, sister or brother) nor anyone living in my household is or has been within the past two (2)
years an employee, officer, director or agent of any of the following:
(a)
The Network, any television station owned or operated by the Network,
their licensees, assigns, parents, or affiliated or subsidiary companies;
(b)
Producer, its licensees, assigns, parents, or affiliated or subsidiary
companies, or any person or entity involved in the development, production, distribution or other
exploitation of the Series or any variation thereof;
(c)
Endemol or Endemol USA Inc., its licensees, assigns, parents, or
affiliated or subsidiary companies;
(d)
Any previously announced sponsor of the Series or its advertising
(e)
Any person or entity supplying services or prizes to the Series.
agency; or
Is the foregoing statement true? YES
If the above is not true, please explain:
NO
In addition, I acknowledge and agree that Producer has the sole discretion to render
ineligible any person who, in Producer’s sole discretion, is sufficiently connected with the production,
administration, judging or distribution of the Series that his or her participation in the Series could create
the appearance of impropriety.
27.
I have listed below, to the best of my knowledge, anyone I know who is now, or
has been in the past two (2) years, an employee, agent or representative of:
(a)
The Network, its parent, subsidiaries or affiliated companies, any of their
licensees, successors or assigns, or any affiliated television station, or any television station that
broadcasts the Series;
(b)
Producer, Endemol, Endemol USA Inc., their respective parent,
subsidiary, or affiliated companies, any of their licensees, successors or assigns, or any other
person or entity involved in the development, production, distribution or other exploitation of the
Series or any version or variation thereof;
(c)
Any television station or channel, cable network, or satellite network that
may air the Series or any variation thereof;
(d)
Any previously announced sponsor of the Series or its advertising
agency;
(e)
Any officer, director, agent, representative or employee of any of the
persons or entities listed in this paragraph, or any person or entity involved with the Series; or
(f)
Any persons or entity supplying services or prizes to the Series.
If you do not know anyone who fits the above categories, please write “None” in the space
below.
________________________________________________________________
________________________________________________________________
________________________________________________________________
28.
YES:
I am currently a candidate or serve in public office.
NO:
If selected to participate in the Series, I agree not to become a candidate for public office
from the date of my signing this Agreement until one (1) year after the initial broadcast of all episodes in
which I appear in the Series and my appearance on any reunion or related program, whichever is later.
29.
I represent and warrant that I have no confidential knowledge of or access to,
and I do not know anyone with confidential knowledge of or access to, any material, assignments,
challenges or competitions that may be selected for possible use in the Series.
30.
The following are ALL of the television contest, game, or “reality” shows on
which I have EVER appeared (if none, please write “None” in the space below):
Name of Show
Tape Date
Air Date
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
I understand and agree that Producer reserves the right to disqualify me from participation based
on the amount or nature of my participation in prior television contest, game, or reality shows
and/or the amount of my other exposure in any media. I further understand that such
determination will be made by Producer in its sole discretion.
31.
The following are ALL of the television contest, game, or reality shows for
which I have applied to be a contestant or participant within the last year (if none, please write “None”
in the space below):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
32.
The following are ALL of the magazines, publicly disseminated photographs and
advertisements (including, without limitation, on the Internet) in which I have appeared (attach additional
pages if necessary):
________________________________________________________________
________________________________________________________________
________________________________________________________________
I understand and agree that Producer, in its sole discretion, may render ineligible and disqualify
from participation any person based on the extent and quality of such person’s prior exposure in
any media.
33.
I will immediately notify Producer if I apply to be a contestant or participant on
any other contest, game or reality show while still being considered for the Series or after being selected
to be a contestant on the Series. In the event I am selected to be a contestant on the Series I shall
immediately withdraw any pending application to participate in any other contest, game or reality show.
YES:
NO:
34.
I have listed and described below the only instances in my life in which I was
ever detained for or accused of wrongdoing, including, without limitation, for any crime or for reckless or
drunk driving (if none, please write “None” in the space below):
The following is a detailed description of each such arrest, detention, accusation, and/or
conviction, including, without limitation, the reason(s), the place(s), the date(s), the precise
charge(s) and the resolution(s):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
35.
I have listed and described below any and all criminal proceedings to which I
have been a party (if none, please write “None” in the space below).
The following is a detailed description of each such criminal proceeding, including, without
limitation, the reason(s), the place(s), the date(s), the precise charge(s) and the plea or
resolution(s):
________________________________________________________________
________________________________________________________________
________________________________________________________________
__________________________________________________________
36.
I have listed and described below any and all civil lawsuits and/or court
proceedings to which I have been a party (if none, please write “None” in the space below).
(Provide a detailed description of each such lawsuit and proceeding, including, without limitation,
the date(s), the place(s), the court(s), the other party or parties to the lawsuit(s), the nature of the
lawsuit(s), the events underlying the lawsuit(s), and the outcome of the lawsuit(s)):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
37.
I have served in the military.
TRUE
FALSE
If TRUE, I acknowledge and agree that I have completed or will complete a form authorizing
disclosure of my military records to Producer and the Network.
If TRUE, branch of military:
Dates of Service
Type of Discharge:
38.
I have listed and described below any and all disciplinary proceedings or actions
at school, in the military, at work or in any other context or setting in which I have been involved (if
none, please write “None” in the space below).
The following is a detailed description of each such disciplinary proceeding and/or action,
including, without limitation, date(s), place(s), exact nature of charge(s), the identity(ies) of the
person(s) and/or tribunal(s) conducting the proceeding(s), the findings made by the person(s)
and/or tribunal(s) conducting the proceeding(s), the results of the proceeding(s), and any action(s)
taken:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
39.
I have listed and described below any and all incidents in which a temporary
restraining order has been sought and/or issued against me (if none, please write “None” in the space
below).
The following is a detailed description of each such incident, including, without limitation,
date(s), place(s), exact nature of charge(s), whether a temporary restraining order was issued
against me, and the basis upon which the temporary restraining order was sought and/or issued:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
40.
I have listed and described below anything I have ever done or been involved
with (including, without limitation, any illegal or otherwise wrongful conduct) that, if exposed, might
reflect negatively on me, Producer or the Network, or cause Producer or the Network any embarrassment
or monetary loss, if I am chosen to participate in the Series (if none, please write “None” in the space
below).
The following is a detailed description of each such incident, including, without limitation,
date(s), place(s), the exact nature of the incident(s), and any publicity in connection with the
incident(s):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
41.
I have listed and described below any and all websites I have created and/or any
and all materials I have posted on any website (if none, please write “None” in the space below).
The following is a description of each website I have created and/or all of the materials I have
posted on any website:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
42.
Although Producer may obtain insurance covering certain limited damages
arising out of my accidental death and/or disability, and certain medical expenses arising out of my care, I
acknowledge that Producer has no obligation to do so, and that Producer recommends that I maintain my
own accident and health insurance, and verify that any losses or injuries that may occur during my
participation in the Series will be covered under such insurance. Although not required as a condition to
my participation in the Series, as between Producer and myself, I acknowledge that should I elect to
maintain such insurance, I alone am responsible for maintaining accident and health insurance to cover
any medical expenses, bodily injury and/or personal property damage, as well as any insurance to cover
my short-term or long-term disability from any injury and any insurance to cover my death. The waivers,
releases, and indemnities set forth in this Agreement and any other agreement that I have executed or that
I may execute in connection with the Series expressly apply to any such provision of insurance by
Producer. If I currently maintain health insurance, my health insurance carrier and identification number,
and my health insurance carrier’s address and telephone number, are listed below (if none, please write
“None” in the space below):
43.
If I have been professionally trained or have appeared as an entertainer, a
description of my training or appearance(s) follows (if none, please write “None” in the space below):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
44.
If I am a member of a performing arts union or guild, a complete list of all such
unions and/or guilds follows (if none, please write “None” in the space below):
________________________________________________________________
________________________________________________________________
45.
I acknowledge and agree that, if I am selected by Producer to be a contestant, my
appearance as a contestant in the Series is not a performance and is not employment and is not subject to
any union or guild collective bargaining agreement, and does not entitle me to wages, salary, corporate
benefits, workers’ compensation benefits, or other compensation under any such collective bargaining
agreement or otherwise.
46.
I represent and warrant that all statements, disclosures and representations made
by me in this Agreement, in my Application, and in any other document or agreement that I have signed
or may sign in the future in connection with the Series or my participation in the Series, as well as all of
the information of every kind and nature whatsoever that I have provided to Producer, are true, accurate
and complete. Without in any way limiting the foregoing, I certify that I have not withheld or
mischaracterized any information regarding myself or my background. I also agree to immediately
inform Producer if any of the information I provide becomes inaccurate or incomplete ay any time prior
to the initial broadcast of the final episode of the Series. In addition, I agree that Producer may disclose
any and all of such statements, disclosures and representations, as well as any and all information
provided by me or provided by others about me to any person for any purpose, on or off-air. If any
statement, disclosure, representation or information I make or provide is false, misleading or incomplete,
Producer may remove me from consideration as a contestant in the Series, may remove me from the
Series, may withhold from me any prizes and monies that I won, and/or may cause me to return any
prizes and monies already delivered to me. I also recognize that proof of damages suffered by Producer
and the Network in the event that I breach any provision of this paragraph will be costly, difficult or
inconvenient. Accordingly, I agree to pay Producer and the Network the sum of One Million Dollars
($1,000,000) per breach plus disgorgement of any money or the value of any thing that I have received or
that I may receive in connection with my breach as liquidated damages in the event I breach any provision
of this paragraph. Furthermore, I will defend, indemnify and hold harmless the Released Parties (as
defined in paragraph 67) from and against any and all claims, actions, damages, liabilities, losses, costs
and expenses (including, without limitation, attorneys’ fees) that in any way arise out of or result from my
breach of any provision of this paragraph.
47.
Selection of contestants shall be made by Producer based on such criteria as
Producer shall determine in its sole discretion, which may be subjective. Producer is not obligated to
select me, even if I meet all eligibility requirements and all criteria for selection. Producer’s decision
regarding the selection of contestants is final, binding and not subject to challenge or appeal. If I am
selected, Producer is not obligated to have me appear on the Series, and Producer shall have the right at
any and all times and in its sole discretion to remove or replace me as a contestant in connection with the
Series for any reason or no reason. Even if I am selected, and even if I participate as a contestant on the
Series or any part thereof, neither Producer nor Network is obligated to broadcast or otherwise use or
exploit the Series, the Material or any part of either the Series of the Material. Furthermore, Producer or
Network may broadcast the Series with or without the Material or any portion thereof, as Producer may
determine in its sole discretion.
48.
I understand and acknowledge that Producer may cancel production of the Series
at any time, for any reason, in its sole discretion, without any obligation to me whatsoever, other than to
pay me any winnings earned by me, prior to the date of cancellation.
49.
All materials used by me in connection with the Series shall be subject to
Producer’s prior approval.
50.
If I perform or include any music (other than music supplied to me by Producer)
as part of my appearance in the Series, then I represent and warrant that I have obtained all rights,
including, without limitation, synchronization rights, necessary for Producer to exploit the Series
inclusive of such music. I grant Producer the right to record, reproduce and publicly perform such music,
as is necessary to produce, tape, broadcast, and promote the Series. I waive all claims to and agree that I
shall receive no royalties of any kind now or in the future from Producer for the use of such music on the
Series, including, without limitation, copyright, public performance, mechanical or synchronization
royalties. If I display in the Series or submit to Producer for display in the Series any photographs,
published works and/or other artistic or other copyrightable materials, then I represent and warrant that I
have obtained all of the rights, clearances and releases necessary for Producer and the Network to exploit
said materials in and in connection with the Series, in the Advertisements and otherwise pursuant to
Producer’s rights hereunder.
51.
I will not bring any weapons, illegal drugs, or other illicit items when traveling to
or when at any Location and I will not engage in, any illegal activities when traveling to or when at any
Location.
52.
I further understand and agree that I am prohibited from wearing any apparel in
the Series, including, but not limited to, shirts, pants, shorts and hats, that contain any recognizable logos
or trademarks unless such apparel has been specifically provided to me or approved in advance by
Producer.
53.
Neither I, nor anyone acting or my behalf, shall at any time use any of Producer’s
or the Network’s names, logos, trade names or trademarks (including, but not limited to, the title of the
Series), or those of any of Producer’s or the Network’s related companies, for any purpose or in any
manner whatsoever, including, without limitation, in or in connection with any kind of advertising,
promotion, publicity, merchandise, or other product or service.
54.
I shall not mention or “plug” any commercial product, service, venture or thing
on the Series, including, without limitation, the name of my employer. I am not, and no one acting on my
behalf is, giving or receiving, nor have I or anyone acting on my behalf given or received, any monies or
other valuable consideration (including, without limitation, a division of any prizes) in connection with
my appearance on the Series, and I have not authorized and will not authorize, and no one acting on my
behalf has authorized or will authorize, anyone else to do so. I am aware that payment or acceptance of,
or agreement to pay or accept, any money or valuable consideration for the appearance of any person or
the mention of any thing on the Series without disclosure to the Network or other broadcaster prior to
broadcast may be a federal offense punishable by fine and/or imprisonment. I agree that if anyone tries to
induce me to make any such product mention or placement or to do any such act or accept any such
money or consideration, I shall immediately notify Producer and a representative of the Network.
55.
I am aware that it may be a federal offense punishable by fine and/or
imprisonment for anyone to do anything which would rig or in any way influence the outcome of the
Series with intent to deceive the viewing public (including, without limitation, colluding to share any
prize), and that it may be a federal offense to offer or accept any information or special and/or secret
assistance in connection with the Series. I agree that I will not participate in any such act or any other
deceptive or dishonest act with respect to the Series. I acknowledge and agree that any agreement
between me and any other contestant(s) to share any prize, if awarded to me or such other contestant(s),
shall constitute a deceptive or dishonest act hereunder. If anyone tries to induce me to do any such act, I
shall immediately notify Producer and a representative of the Network.
56.
I shall pay all provincial, federal, local or other taxes on any prize or prizes I may
win. As used in this Agreement, “prizes” means, among things, money, goods and services, including,
but not limited to the Prize, merchandise, travel, lodging and/or tickets or access to events (but excluding,
for clarification, lodging at any Location or any travel furnished to or among Locations by Producer at
Producer’s expense in connection with my participation in the Series). I hereby release the Released
Parties of any and all liability in connection with any such taxes. Producer may deduct, withhold or
require payment of any such taxes before delivery of any prize. If payment is required and I do not pay
within ninety (90) days of the broadcast of my appearance, my prize (if any) will be deemed forfeited.
57.
My refusal to accept any prize shall constitute a forfeiture of that prize, and I
hereby release the Released Parties of all obligations in connection with such prize. I shall not advertise
or publicize my winning of any prize, nor sell any prize consisting of travel or lodging.
58.
If for any reason any prize I win cannot be supplied, I shall accept either a prize
of comparable value or a cash amount equal to the fair market value of the prize I won, as determined by
Producer in its sole discretion.
59.
I shall not share, or make any agreement or promise to share, any prize or any
portion of any prize with any other contestant or any other person that I may encounter as a result of my
participation in the Series, and any such purported agreement or promise shall be unenforceable. Prior to
delivery, I may not assign any prize that I win to another person or organization except to a registered
charity and then only with the prior written consent of the Producer and Network.
60.
Producer may freely assign this Agreement and all rights of Producer under this
Agreement, and delegate any of Producer’s obligations to me with respect to my participation in the
Series, and any assignee or delegate may further assign or delegate its obligations. Upon any such
assignment or delegation, Producer shall have no further obligation to me under this Agreement or in
connection with the obligation that is delegated.
61.
I acknowledge that, in the event of a malfunction or dispute of any nature
whatsoever affecting the playing or outcome of any contest or the awarding of any prize, Producer’s
decision with respect to the handling of such malfunction or dispute, including, but not limited to, the
awarding of any prize, shall be final. If any Challenge or activity (or element thereof) in the Series is
halted for any reason, I shall abide by Producer’s decision regarding resumption of the contest and the
disposition of any prize, and the Released Parties will not be liable for any costs, losses or claims caused
by any interruption or by Producer’s not proceeding with the Challenge.
62.
I understand that the commencement of production, the production, and the
completion of production of the Series may be delayed, suspended, terminated or abandoned by Producer
at any time in its sole discretion and for any reason whatsoever, including, without limitation, due to
events within Producer’s control or due to events beyond Producer’s control. If production of the Series
is abandoned or terminated for any reason, no prize will be awarded to any contestant, and I understand
that, in such event, I will forfeit my chance to win any prize. The waivers, releases, and indemnities set
forth in this Agreement and any other agreement that I have executed or that I may execute in connection
with the Series expressly apply to any such delay, suspension, termination, or abandonment of production
of the Series, and to any such forfeiture.
CONFIDENTIALITY
63.
I understand that any appearance that I may make on the Series is strictly for the
purpose of participating in the Series. I consent to the use of my name, biography, voice, photograph
and/or likeness by Producer, the Network, any television station or channel, cable network, or satellite
network that airs the Series, and each of their respective parent, affiliated and subsidiary companies for
advertising and promotional purposes (including, without limitation, in commercial tie-ins), without any
compensation, except where prohibited by law. I understand and agree that all publicity in connection
with the Series is under the sole control of Producer, the Network, and any television station or channel,
cable network, or satellite network that airs the Series. Except as specifically provided herein or as
otherwise authorized by Producer and the Network, I will not myself, or authorize others to, advertise or
promote my participation in the Series, or receive or generate any monetary advantage from my
participation in the Series. Without limiting the foregoing, I will not myself, or authorize others to,
prepare or assist in the preparation of any written work, any audio work, and/or any visual work that
depicts, concerns or relates in any way to my participation in the Series. Therefore, I shall submit to
Producer and the Network for approval any potential participation I may have in any and all publicity
(including, but not limited to, television, radio and print interviews) in connection with my involvement
and/or appearance on the Series and shall not consent to any publicity without the prior approval of
Producer and the Network. I recognize that a breach by me of this paragraph would cause Producer and
the Network irreparable injury and damage that cannot be reasonably or adequately compensated by
damages in an action at law, and, therefore, I hereby expressly agree that Producer and the Network shall
be entitled to injunctive and other equitable relief (without posting bond) to prevent and/or cure any
breach or threatened breach of this paragraph by me. I also recognize that proof of damages suffered by
Producer and the Network in the event that I breach this paragraph will be costly, difficult, or
inconvenient to ascertain. Accordingly, I agree to pay Producer and the Network the sum of One Million
Dollars ($1,000,000.00) per breach plus disgorgement of any income that I may receive in connection
with my breach as liquidated damages in the event I breach this paragraph prior to the initial broadcast of
the final episode of the Series. I agree that One Million Dollars ($1,000,000.00) plus disgorgement of any
income that I may receive in connection with my breach is a reasonable estimate of the amount of
damages Producer and the Network are likely to suffer in the event I breach this paragraph prior to the
initial broadcast of the final episode of the Series, considering all of the circumstances existing as of the
date of this Agreement. In addition, I agree to pay Producer and the Network the sum of One Hundred
Thousand Dollars ($100,000.00) per breach plus disgorgement of any income that results from my breach
as liquidated damages in the event I breach this paragraph after the initial broadcast of the final episode of
the Series. I agree that One Hundred Thousand Dollars ($100,000.00) plus disgorgement of any income
is a reasonable estimate of the amount of damages Producer and the Network are likely to suffer in the
event I breach this paragraph after the initial broadcast of the final episode of the Series, considering all of
the circumstances existing as of the date of this Agreement. Furthermore, I will defend, indemnify and
hold harmless the Released Parties from any and all claims, actions, damages, liabilities, losses, costs and
expenses (including, without limitation, attorneys’ fees) that in any way arise out of or result from my
breach of this paragraph.
64.
I will not use or disclose to any party any information or trade secrets obtained or
learned as a result of my participation in the Series, including, without limitation, any information
concerning or relating to the Series, the contestants, the events contained in the Series (including, but not
limited to, any Challenges), the outcome of the Series, or the contents of this Agreement or any other
agreement or document that I sign, have signed or receive from Producer at any time. I shall keep in
strictest confidence and shall not disclose to any contestant or any other third party at any time (i.e., prior
to, during, or after the taping or broadcast of any episode of the Series) any information or materials of
any kind, including without limitation, any information or materials concerning or relating to Producer
and/or the Network, specifically including, without in any way limiting the generality of the foregoing,
any information concerning or relating to the Series, the Series contestants, the Location(s) of the Series,
the events contained in the Series or the outcome of any Challenge in or episode of the Series, that I read,
hear or otherwise acquire or learn in connection with or as a result of my participation in the Series
(collectively, the “Confidential Information and Materials”). Without limiting the foregoing in any way, I
will not myself, or authorize others to, prepare or assist in the preparation of any written work, any audio
work, and/or any visual work, including, without limitation, any website or information on the Internet,
that depicts, concerns or relates in any way to my participation in the Series or the Confidential
Information and Materials. I acknowledge and agree that the Confidential Information and Materials are
confidential and the exclusive property of Producer and/or the Network. During and after the time that I
participate in any way in connection with the Series, I will not, directly or indirectly, divulge in any
manner, or use or permit others to use, any of the Confidential Information or Materials. I recognize that a
breach by me of this paragraph would cause Producer and the Network irreparable injury and damage that
cannot be reasonably or adequately compensated by damages in an action at law, and, therefore, I hereby
expressly agree that Producer and the Network shall be entitled to injunctive and other equitable relief
(without posting bond) to prevent and/or cure any breach or threatened breach of this paragraph by me. I
also recognize that proof of damages suffered by Producer and the Network in the event that I breach this
paragraph will be costly, difficult, or inconvenient to ascertain. Accordingly, I agree to pay Producer and
the Network the sum of One Million Dollars ($1,000,000.00) per breach plus disgorgement of any income
that I may receive in connection with my breach as liquidated damages in the event I breach this
paragraph prior to the initial broadcast of the final episode of the Series. I agree that One Million Dollars
($1,000,000.00) plus disgorgement of any income that I may receive in connection with my breach is a
reasonable estimate of the amount of damages Producer and the Network are likely to suffer in the event I
breach this paragraph prior to the initial broadcast of the final episode of the Series, considering all of the
circumstances existing as of the date of this Agreement. In addition, I agree to pay Producer and the
Network the sum of One Hundred Thousand Dollars ($100,000.00) per breach plus disgorgement of any
income that results from my breach as liquidated damages in the event I breach this paragraph after the
initial broadcast of the final episode of the Series. I agree that One Hundred Thousand Dollars
($100,000.00) plus disgorgement of any income is a reasonable estimate of the amount of damages
Producer and the Network are likely to suffer in the event I breach this paragraph after the initial
broadcast of the final episode of the Series, considering all of the circumstances existing as of the date of
this Agreement. Furthermore, I will defend, indemnify and hold harmless the Released Parties from any
and all claims, actions, damages, liabilities, losses, costs and expenses (including, without limitation,
attorneys’ fees) that in any way arise out of or result from my breach of this paragraph.
65.
I irrevocably grant and release to Producer and the Network, in perpetuity and
throughout the universe, the non-exclusive right, if I am selected as a contestant in the Series, to depict,
portray and represent me and my life and all episodes, exploits, events, incidents, situations and
experiences contained in or associated or related to my life which occur, will occur or have occurred at
any time (including without limitation my experiences in connection with the Series) (my “Life Story”)
and the exclusive right to the Material in and in connection with theatrical motion pictures, television
programs and series, theatrical stage presentations, Internet websites, Internet programming and other
computer online forms of exploitation, mobile and wireless programming, radio, other audio, visual,
audio-visual, and/or print productions, books, theme park attractions, amusements, and other print
publications (each, a “Production” and collectively, the “Productions”) and in and in connection with the
production, reproduction, exhibition, broadcast, distribution, advertising, publicity, promotion and other
exploitation of the Productions in any and all media, and by any and all means, whether now known or
hereafter devised, and in the exercise of all subsidiary, allied and ancillary rights (e.g., remake, sequel,
theatrical, television, radio, publishing, merchandising, soundtrack album and other similar rights) in the
Productions. Producer and/or the Network may depict, portray me and my Life Story either accurately or
with such liberties and modifications as Producer and/or the Network determines necessary or desirable in
its sole discretion for the purposes of fictionalization, dramatization or any other purposes, including
without limitation, to achieve a humorous or satirical effect, and by means of actors who may or may not
resemble me. I hereby grant to Producer and the Network the perpetual and worldwide right to use my
name, sobriquet, likeness (actual or simulated), photograph, caricature, voice and biographical material in
and in connection with the production, exhibition, advertising, publicity, promotion, merchandising and
other exploitation of any and all Productions, the Network and its programs, products, sponsors or
services including, without limitation, in commercial tie-ins and all rights in any of the foregoing.
RELEASE AND INDEMNITY
66.
AS USED IN THIS AGREEMENT, THE TERM “RELEASING PARTIES” MEANS
AND REFERS TO EACH OF ME, MY HEIRS, NEXT OF KIN, SPOUSE, GUARDIANS, LEGAL
REPRESENTATIVES, EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNS.
67.
AS USED IN THIS AGREEMENT, THE TERM “RELEASED PARTIES” MEANS
AND REFERS TO EACH OF NETWORK, PRODUCER, LONE EAGLE ENTERTAINMENT LTD.,
ENDEMOL, ENDEMOL USA INC., ANY TELEVISION STATION OR CHANNEL OR CABLE OR
SATELLITE NETWORK BROADCASTING OR OTHERWISE EXHIBITING THE SERIES, ANY SPONSORS,
ADVERTISERS, AFFILIATES AND DISTRIBUTORS OF THE SERIES, AND EACH OF THEIR
RESPECTIVE PARENTS, SUBSIDIARY ENTITIES, RELATED ENTITIES, AFFILIATES, SUCCESSORS
AND ASSIGNS, AND THE RESPECTIVE DIRECTORS, OFFICERS, EMPLOYEES, AGENTS,
CONTRACTORS, PARTNERS, SHAREHOLDERS, REPRESENTATIVES AND MEMBERS OF EACH OF
THE FOREGOING ENTITIES, AND THE HEIRS, NEXT OF KIN, SPOUSES, GUARDIANS, LEGAL
REPRESENTATIVES, EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNS OF EACH OF THE
FOREGOING.
I AND THE OTHER RELEASING PARTIES HEREBY UNCONDITIONALLY AND
IRREVOCABLY AGREE THAT I AND THE RELEASING PARTIES WILL NOT SUE OR CLAIM AGAINST
ANY OF THE CONTESTANTS IN THE SERIES, OR ANY OF THEIR HEIRS, NEXT OF KIN, SPOUSES,
GUARDIANS, LEGAL REPRESENTATIVES, EXECUTORS, ADMINISTRATORS, SUCCESSORS AND
ASSIGNS, OR ANY OF THE RELEASED PARTIES FOR ANY INJURY, ILLNESS, DAMAGE, LOSS OR
HARM TO ME OR MY PROPERTY, OR MY DEATH, HOWSOEVER CAUSED, RESULTING OR ARISING
OUT OF OR IN CONNECTION WITH MY PREPARATION FOR, PARTICIPATION AND APPEARANCE IN
OR ELIMINATION FROM THE SERIES OR ACTIVITIES ASSOCIATED WITH THE SERIES, WHETHER
OCCURRING BEFORE, DURING OR AFTER MY ACTUAL PARTICIPATION IN THE SERIES, AND
68.
WHETHER OR NOT CAUSED BY OR ARISING OUT OF THE NEGLIGENCE OR GROSS NEGLIGENCE
OR BREACH OF CONTRACT OF ANY OF THE RELEASED PARTIES OR OF ANY OF THE
CONTESTANTS IN THE SERIES.
69.
I AND THE OTHER RELEASING PARTIES HEREBY UNCONDITIONALLY AND
IRREVOCABLY RELEASE AND FOREVER DISCHARGE EACH OF THE OTHER CONTESTANTS IN
THE SERIES, EACH OF THEIR HEIRS, NEXT OF KIN, SPOUSES, GUARDIANS, LEGAL
REPRESENTATIVES, EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNS, AND EACH OF
THE RELEASED PARTIES FROM AND AGAINST ANY AND ALL CLAIMS, LIENS, AGREEMENTS,
CONTRACTS, ACTIONS, SUITS, COSTS, ATTORNEYS’ FEES, DAMAGES, JUDGMENTS, ORDERS
AND LIABILITIES OF WHATEVER KIND OR NATURE IN LAW, EQUITY OR OTHERWISE, WHETHER
NOW KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, AND WHETHER OR NOT
CONCEALED OR HIDDEN (COLLECTIVELY, THE “RELEASED CLAIMS”) ARISING OUT OF OR IN
CONNECTION WITH MY TRAVEL IN CONNECTION WITH, MY PREPARATION FOR,
PARTICIPATION OR APPEARANCE IN OR ELIMINATION FROM THE SERIES OR ACTIVITIES
ASSOCIATED WITH THE SERIES, WHETHER OCCURRING BEFORE, DURING OR AFTER MY
ACTUAL PARTICIPATION IN THE SERIES, OR PRODUCER’S PRODUCTION AND EXPLOITATION
OF THE SERIES, OR PRODUCER’S EXERCISE OF ANY RIGHTS GRANTED BY ME IN THIS
AGREEMENT, INCLUDING WITHOUT LIMITATION CLAIMS FOR ANY INJURY, ILLNESS, DAMAGE,
LOSS OR HARM TO ME OR MY PROPERTY, OR MY DEATH, OR ANY INJURY, ILLNESS, DAMAGE,
LOSS OR HARM TO ANY RELEASING PARTIES OR ANY THIRD PARTIES OR ANY OF THEIR
PROPERTY, OR THE DEATH OF ANY RELEASING PARTIES OR ANY THIRD PARTIES. THE
RELEASED CLAIMS SHALL INCLUDE BUT NOT BE LIMITED TO THOSE BASED ON NEGLIGENCE
OR GROSS NEGLIGENCE OR BREACH OF CONTRACT OF ANY OF THE RELEASED PARTIES OR
ANY OF THE OTHER CONTESTANTS IN THE SERIES, WRONGFUL DEATH, PERSONAL INJURY,
INFLICTION OF EMOTIONAL DISTRESS (BOTH NEGLIGENT AND INTENTIONAL), PRODUCTS
LIABILITY, BREACH OF CONTRACT, BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE
OWED UNDER APPLICABLE LAWS, LIBEL, SLANDER, DEFAMATION, INVASION OF PRIVACY,
PUBLICITY OR PERSONALITY, INFRINGEMENT OF COPYRIGHT, LOSS OF EARNINGS OR
POTENTIAL EARNINGS AND THOSE BASED ON MY DISSATISFACTION WITH OR MY POSSESSION
OR USE OF ANY PRIZE.
70.
I and the other Releasing Parties acknowledge that there is a
possibility that subsequent to the execution of this Agreement, I or they will discover facts
or incur or suffer claims which were unknown or unsuspected at the time this Agreement
was executed, and which if known by me at that time may have materially affected my
decision to execute this Agreement. I and the other Releasing Parties acknowledge and
agree that by reason of this agreement, and the release contained in the preceding
paragraphs, I and the other Releasing Parties are assuming any risk of such unknown
facts and such unknown and unsuspected claims.
71.
I AND THE OTHER RELEASING PARTIES IRREVOCABLY AGREE TO
DEFEND, INDEMNIFY AND HOLD HARMLESS EACH OF THE RELEASED PARTIES FROM AND
AGAINST ANY AND ALL CLAIMS BY WHOMEVER ASSERTED ARISING OUT OF OR IN CONNECTION
WITH (A) ANY BREACH OR ALLEGED BREACH OF ANY AGREEMENT, COVENANT,
REPRESENTATION, WARRANTY MADE BY ME IN THIS AGREEMENT OR ANY OTHER AGREEMENT
ENTERED INTO BY ME IN CONNECTION WITH THE SERIES, (B) PRODUCER’S OR NETWORK’S USE
OR OTHER EXPLOITATION OF ANY OF THE RIGHTS GRANTED HEREIN (OR PURSUANT TO OTHER
DOCUMENTS EXECUTED BY ME IN CONNECTION WITH THE SERIES) BY ME TO PRODUCER OR
NETWORK OR (C) MY TRAVEL IN CONNECTION WITH, MY PREPARATION FOR, PARTICIPATION
OR APPEARANCE IN OR ELIMINATION FROM THE SERIES OR THE ACTIVITIES ASSOCIATED WITH
THE SERIES, WHETHER OCCURRING BEFORE, DURING OR AFTER MY ACTUAL PARTICIPATION
IN THE SERIES, INCLUDING WITHOUT LIMITATION ANY INJURY, ILLNESS, DAMAGE, LOSS,
HARM OR DEATH I OR ANY RELEASING PARTIES OR ANY THIRD PARTIES MAY SUFFER
THEREFROM AND ANY STATEMENT, ACTION OR OMISSION OF MINE DURING OR IN CONNECTION
WITH THE SERIES OR RESULTING DIRECTLY OR INDIRECTLY FROM THE SERIES (WHETHER
BEFORE, DURING OR AFTER MY ACTUAL PARTICIPATION IN THE SERIES), AND MY USE OR
POSSESSION OF ANY PRIZE.
Initial
Here
ADDITIONAL PARTICIPATION
72.
I agree that, if I am selected as a contestant for the Series, Producer and/or
Network shall have the exclusive and irrevocable option to film or tape up to three (3) additional episodes
relating to the Series, including, without limitation, a reunion, “making of,” casting, or “All-Stars”
program or series (the “Special Episodes”), to be produced within three (3) years after the initial
exhibition of the final episode of the Series in which I appear (the “Special Episodes Option”). Producer
and /or Network shall exercise the Special Episodes Option in writing at least thirty (30) days prior to the
commencement date of principal photography or taping of the Special Episodes. I agree to participate in
production of the Special Episodes for a period to be determined by Producer and/or Network (the
“Special Episodes Production Period”), at one or more locations, and to participate in the Special
Episodes to the same extent and degree that I have agreed to participate in the Series (including, without
limitation, compliance with any series rules and participation in all series contests and other activities). I
hereby grant Producer and/or Network all rights in the Special Episodes as if the same had been included
in the “Material”, and I agree that all other provisions of this Agreement (including, without limitation,
the provisions relating to participation, publicity, and confidentiality), as well as my Application and all
other agreements that I have executed or that I may execute in connection with the Series, shall apply
equally to my participation in and in connection with any Special Episodes.
MEDIATION, ARBITRATION & LIMITATION OF REMEDIES
73.
If any controversy or claim arising out of or relating to this Agreement, the
breach of any term hereof, or my participation in or in connection with the Series cannot be settled
through direct discussions, the parties agree to endeavor first to settle the controversy or claim by
mediation conducted in the City of Toronto, Province of Ontario and administered by a mutually
agreed mediator, before commencing any proceedings under the procedures set forth in
hereinbelow. Notwithstanding the foregoing, if any party files suit in court, the other party or
parties need not demand mediation to enforce the right to compel arbitration.
74.
I agree that any and all disputes or controversies arising under this
Agreement, any effort by any party to enforce, interpret, construe, rescind, terminate or annul this
Agreement, or any provision thereof, shall be resolved by binding arbitration to be conducted in the
City of Toronto in accordance with the following procedure: either (i) the Producer and I shall
mutually select an arbitrator, who shall be a retired judge of a provincial or federal court or a
lawyer licensed to practice in the Province of Ontario with background in entertainment matters
(ii) if the Producer and I cannot agree on such arbitrator, the Producer and I shall each select one
arbitrator, who shall both be retired judges of provincial or federal courts and those two
arbitrators shall then select a third arbitrator, who shall be a retired judge of a provincial or
federal court. All arbitration proceedings shall be conducted under the rules of the Arbitration Act
(Ontario) in effect as of the date the request for arbitration is filed. I agree that the arbitrator’s
ruling, or arbitrators’ ruling, as applicable, in the arbitration shall be final and binding and not
subject to appeal or challenge. I further agree that the arbitration proceedings, testimony,
discovery and documents filed in the course of such proceedings, including the fact that the
arbitration is being conducted, will be treated as confidential and will not be disclosed to any third
party to such proceedings, except the arbitrator(s) and their staff, the parties’ attorneys and their
staff, and any experts retained by the parties; provided that such arbitrator(s) and their staff, the
parties’ counsel and their staff, and any experts retained by the parties each first agree in writing
that such information and documents will be treated by them as confidential, consistent with this
provision. Any judgment upon an award rendered by an arbitrator may be entered in any
Canadian provincial or federal court. The parties agree that the arbitrator may only award
remedies consistent with the terms of this Agreement, including, without limitation, paragraphs 76
and 77.
75.
The parties agree that any mediation or arbitration proceedings, testimony,
or discovery, along with any documents filed or otherwise submitted in the course of any such
proceedings (and including the fact that the mediation or arbitration is even being conducted) shall
be confidential and shall not be disclosed to any third party except to the mediators or arbitrators
and their staff, the parties’ attorneys and their staff and any experts retained by the parties, or as
required by law. Notwithstanding the foregoing, a party may disclose limited information if
required in any judicial proceeding brought to enforce these arbitration provisions or any award
rendered hereunder.
76.
The parties agree that remedies for any breach of this Agreement, or any
other claims concerning or relating to the Series, shall be limited to actual damages (except for
Producer and the Network’s right to liquidated damages as provided in paragraphs 46, 63, and 64),
and in no event shall either party be entitled to recover punitive or exemplary damages or to
rescind this Agreement or seek injunctive or any other equitable relief (except as otherwise
provided in paragraphs 63, 64 and 77 herein). Notwithstanding the foregoing, if and to the extent
required by law, the parties agree that with respect to the arbitration of any claim not otherwise
waived herein and brought under any federal or provincial statute that mandates specific types of
unwaivable remedies, the arbitrator may award any remedy mandated by such statute.
77.
Notwithstanding the foregoing, I recognize and acknowledge that given the
unique nature of the Series and the commercial realities of the entertainment industry, which rely
upon confidentiality and intellectual property rights, an actual or anticipated breach of my
publicity or confidentiality obligations pursuant to this Agreement, or any infringement by me of
Producer’s or the Network’s intellectual property rights would cause Producer and the Network
irreparable injury and damage that cannot be reasonably or adequately compensated by money
and, therefore, I hereby agree that Producer and the Network shall also be entitled to seek and
obtain injunctive and other equitable relief from any court of competent jurisdiction for any such
breach or infringement.
78.
If any portion of the dispute resolution mechanism set forth hereinabove is
found to be invalid, illegal or unenforceable for any reason, that portion shall be severed from the
rest and shall not affect the parties’ agreement to resolve all controversies and claims through
mediation and arbitration.
Initial
Here
MISCELLANEOUS
79.
Nothing herein contained shall be deemed to constitute an employment
relationship, joint venture or partnership between me and Producer or between me and the Network, nor
shall I be deemed Producer’s or the Network’s agent for any purpose.
80.
Any waiver of any term of this Agreement in a particular instance shall not be a
waiver of such term for the future. I agree that the invalidity or enforceability of any part of this
Agreement shall in no way affect the validity or enforceability of any of the remainder of this Agreement.
All remedies, rights, undertakings, obligations, and agreements contained in this Agreement shall be in
addition to and shall not limit any other remedy or right of the Producer.
81.
I represent and warrant that I have had the opportunity to review this Agreement
before signing it. Accordingly, no presumption for or against Producer or me arising out of the drafting
of all or any part of this Agreement will apply or will be applied in any arbitration or other legal
proceeding relating to or involving this Agreement or my appearance on the Series.
82.
This Agreement, the exhibits and attachments hereto, my Application, and any
other agreements or documents that I have executed or that I may execute at the request of Producer or
the Network constitute the entire agreement and understanding between the parties concerning the subject
matter hereof, and supersede and replace all prior negotiations, proposed agreements and agreements,
written and oral, relating thereto, and cannot be changed or terminated except by a written instrument
signed by the parties hereto. In the event of any inconsistency between my Application or any other
agreements or documents executed by me at the request of Producer or the Network, on the one hand, and
this Agreement, on the other hand, the terms, conditions and obligations set forth in this Agreement shall
govern the rights and obligations of the parties.
83.
I acknowledge that no other party, nor any agent or attorney of any other party,
has made any promise, representation or warranty whatever, express or implied, oral or written, not
contained herein concerning the subject matter hereof, to induce me to execute this Agreement, and I
acknowledge that I have not executed this Agreement in reliance on any such promise, representation, or
warranty not contained herein.
84.
I acknowledge and agree that the Network is an express, intended third party
beneficiary of this Agreement with full standing to enforce any and all of the provisions of this
Agreement.
85.
This Agreement shall bind and inure to the benefit of the parties hereto and their
respective successors, assigns, licensees, heirs, legal representatives, administrators, executors, and
guardians. This Agreement is personal to me and is not assignable by me, and any purported assignment
by me shall be null and void ab initio. This Agreement and any and all rights and obligations of Producer
and/or the Network under this Agreement may be freely assigned by Producer and/or the Network (as
applicable).
86.
I agree to execute and deliver to Producer any other documents that Producer
considers necessary or desirable to evidence, effectuate or enforce this Agreement or any of the terms and
conditions hereof. I hereby appoint Producer my true and lawful attorney-in-fact to execute and deliver
any such documents in the event I fail or refuse to do so in accordance with this Agreement promptly
after Producer’s written request therefor (which appointment is deemed a power coupled with an interest
and irrevocable under any and all circumstances).
87.
This Agreement shall be deemed to be entered into in Toronto, Ontario and shall
be governed by and interpreted in accordance with the laws of the Province of Ontario and the laws of
Canada applicable herein. To the extent that I or the Producer has the right to determine any issue in a
court of law, I hereby attorn to the jurisdiction of the courts of the Province of Ontario situated in the City
of Toronto.
88.
I agree that all information that I have provided in this Agreement, the
Application and otherwise to the Producer, Network and Endemol may be incorporated into the
Series, including, without limitation, the production, distribution, exhibition, advertising,
publicizing, merchandising, or other exploitation thereof, throughout the universe, in any
manner, by any method, and in any and all media, whether currently existing or hereafter
developed (including, without limitation, the Internet), in perpetuity whether as part of the
Series, any subsequent seasons of the Series, any ancillary or related productions including
“making-of” and “behind-the-scenes” productions, any promotional materials, or otherwise. By
signing this Agreement, I consent to the collection, use and disclosure of my personal
information in the ways stated in this paragraph, in the Agreement and the Application. The
Producer, Network and Endemol will not use my personal information for any other purpose not
disclosed in this paragraph, the Agreement and the Application without contacting me first for
my permission to do so.
89.
I HAVE BEEN GIVEN AMPLE OPPORTUNITY TO READ, HAVE BEEN ADVISED OF
MY RIGHT TO OBTAIN INDEPENDENT LEGAL ADVICE WHICH I EXPRESSLY WAIVE AND CONFIRM I
HAVE CAREFULLY READ, THIS ENTIRE AGREEMENT. I REPRESENT AND WARRANT THAT I HAVE THE
FULL RIGHT, POWER AND AUTHORITY TO GRANT THE RIGHTS GRANTED IN THIS AGREEMENT. I
CERTIFY THAT I HAVE MADE SUCH NECESSARY INVESTIGATION OF THE FACTS PERTINENT TO THIS
AGREEMENT AND OF ALL THE MATTERS PERTAINING THERETO AS I HAVE DEEMED NECESSARY, THAT
I FULLY UNDERSTAND THE CONTENTS OF THIS AGREEMENT, THAT I AM OF SOUND MIND AND HAVE
MENTAL CAPACITY, AND THAT I, MY HEIRS, EXECUTORS, ADMINISTRATORS, SUCCESSORS AND
ASSIGNS INTEND TO BE LEGALLY BOUND BY THIS AGREEMENT. I AM AWARE THAT THIS AGREEMENT
IS AND CONSTITUTES A COMPLETE WAIVER, RELEASE AND AGREEMENT TO INDEMNIFY AND IS
AMONG OTHER THINGS, A COMPLETE BAR, WAIVER AND RELEASE OF LIABILITY FOR ANY AND ALL
ACTIONS, CAUSES OF ACTION, CLAIMS, OR DEMANDS FOR DAMAGES, LOSS, INJURY OR DEATH
PURSUANT TO THE LAWS OF ANY COUNTRY OR JURISDICTION, HOWSOEVER ARISING EITHER NOW OR
WHICH MAY ARISE AT A FUTURE DATE IN BOTH NEGLIGENCE OR CONTRACT. I, MY HEIRS,
EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNED HEREBY AGREE TO ASSUME ALL RISKS
OF PERSONAL INJURY AND DEATH WHETHER INHERENT OF OTHERWISE AND CONSEQUENT DAMAGES
ARISING FROM ALL MATTERS AND ACTIVITIES REFERRED TO IN THIS AND ALL RELATED DOCUMENTS
AND AGREEMENTS. I FURTHER CONFIRM THAT SUCH WAIVER AND RELEASE OF LIABILITY IN
CONTRACT AND TORT REFERRED TO HEREIN IS A BINDING LEGAL DOCUMENT AND CONTRACT
BETWEEN MYSELF AND ALL PAST AND PRESENT PRODUCERS, AFFILIATED ORGANIZATIONS,
INCLUDING AND NOT LIMITED TO PRODUCER, LONE EAGLE ENTERTAINMENT LTD., ENDEMOL,
ENDEMOL USA INC., ANY TELEVISION STATION OR CHANNEL OR CABLE OR SATELLITE NETWORK
BROADCASTING OR OTHERWISE EXHIBITING THE SERVICES, ANY SPONSORS, ADVERTISERS,
AFFILIATES, SUBSIDIARIES, DISTRIBUTORS, ALL EQUIPMENT MANUFACTURERS AND SUPPLIERS,
AGENTS, SERVANTS, EMPLOYEES, INDEPENDENT CONTRACTORS, DIRECTORS, OFFICERS, PARTNERS,
SHAREHOLDERS, REPRESENTATIVES AND MEMBERS OF EACH OF THE FOREGOING ENTITIES, AND
THEIR HEIRS, NEXT OF KIN, SPOUSES, GUARDIANS, LEGAL REPRESENTATIVES, EXECUTORS,
ADMINISTRATORS, SUCCESSORS AND ASSIGNS, AND THAT I AM SIGNING THIS AGREEMENT OF MY
OWN FREE WILL. ALL STATEMENTS MADE BY ME IN THIS AGREEMENT ARE TRUE. THE NAME GIVEN
BELOW IS MY LEGAL NAME. ANY OTHER NAME(S) OR ALIAS(ES) USED BY ME WITHIN THE PAST FIVE
YEARS ARE ALSO NOTED BELOW.
DATED:
DATED:
APPLICANT
1817141 Ontario Inc.
Name:
By:______________________________
Signature:____________________________
Its:______________________________
SIN # :
Address:________________________________________________________________
_______________________________________________________________________
Date of Birth:____________________________________________________________
Phone Home:________________Business:____________Cell:_____________________
Email Address: ______________
Other Names and Aliases (if applicable):
NOTE: PLEASE KEEP PRODUCER AND THE NETWORK ADVISED IN WRITING OF
YOUR CURRENT ADDRESS AND TELEPHONE NUMBER.
FOR PRODUCTION USE ONLY:
______________________________________________________________________________
EXHIBIT A
AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION
TO: (insert name and address of your Doctor or any Medical Practitioner who you are requesting to
release your information):
Print name of individual authorizing use or disclosure:
(Individual):
SIN#:
Address:
Telephone #:
PARTY RECEIVING INFORMATION: This information may be disclosed to, and used by, the
producers and staff of the program currently entitled “Wipeout Canada” and their authorized agents (the
“Series”) c/o 1817141 Ontario Inc., 72 Stafford St. Suite 400, Toronto, Ontario, M6J 2R9
AUTHORIZATION AND PURPOSE: I authorize the use or disclosure of any and all of my records,
including without limitation those pertaining to mental health, steroid use, HIV/AIDS, genetic testing
and/or substance abuse. The party to which this authorization is addressed is authorized to release all
such records pertaining to services rendered to me or claims or enrollment information pertaining to me
for purposes of selecting or eliminating participants in the Series, for quality assurance and peer review,
and for any other purpose related to the operation of the Series.
NOTICES:
•
This authorization is voluntary.
•
I may revoke this authorization at any time by notifying in writing the company/individual listed
above from providing the information identified in this authorization, but if I do revoke this
authorization, it won’t have any affect on any actions taken before my revocation was received.
Additionally, my revocation of this authorization may result in my being disqualified from any
further participation in the Series, in the sole discretion of the producers of the Series.
•
I would like this authorization to expire on (enter date): _____/_____/_____ (If no expiration date
is provided, this authorization will expire twelve (12) months from the date of receipt; if this
authorization expires before the Series is finished taping, this may result in my being disqualified
from any further participation in the Series, in the sole discretion of the producers of the Series).
•
Information disclosed as a result of this authorization may no longer be protected by privacy laws
and may be disclosed by the entity or individual receiving the authorization.
•
I should retain a copy of this authorization form.
Signature
Date
EXHIBIT B
EMERGENCY MEDICAL RELEASE
Return Completed Form To:
181471 Ontario Inc. (“Producer”)
72 Stafford St., Suite 400
Toronto, Ontario
M6J 2R9
IN CASE OF EMERGENCY, I, by signing below, authorize Producer, Endemol Argentina S.A.., each
of their respective parent, subsidiary and affiliate companies, and each of their respective agents,
employees, representatives, and contractors, to arrange for and/or provide such medical assistance to me
as any of them determines to be necessary.
I also authorize any physician, other medical/paramedical provider, and/or medical facility to provide any
medical/surgical care and/or hospitalization to me, including anesthetics, which any of them determine to
be necessary or advisable, pending receipt of a specific consent from me.
DATE:
SIGNED:
Print Name:
Emergency Contact Name:
Relationship:
Their address:
City:
Province:
Phone: Daytime: (
)
Regular Physician:
Postal Code:
Evening: (
)
Phone: (
)