Ellen's Game of Games

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Hometown City & State *

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Do you have any children? *

If yes, please list names and ages:

Tell us a little bit about yourself and your life. What should we know about you? *

How would your friends describe you? *

How competitive are you? *

Why do you want to be on Ellen's Game of Games? *

What would winning a lot of money mean to you? What would you spend the money on? *

Who would be your ideal teammate(s) if you competed on the show as either a team of two or team of four? Please list the name(s), relationship(s), and contact information for those people below: *

Who else do you know that would be amazing on this show? Please list their name and contact information below:

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How did you hear about the casting? Be specific. *

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Eligibility Requirements *

I represent and warrant that: (a) I am at least 18 years of age and that I am a U.S. citizen or legal resident of the United States with valid social security or tax ID number or have met all requirements under United States immigration, tax or other law(s) to travel to the United States and participate in all Series elements and to be provided and accept any money or prizing in connection with the Series, as determined by Producer in its sole discretion; (b) I am not currently a candidate for public office and agree that I will not become a candidate for publicoffice until at least one (1) year after the initial broadcast or other exhibition of the final episode of the Series in which I appear, if selected as a contestant; (c) I do not presently have any knowledge or access to anyone with knowledge of or access to any material, assignments, challenges or competitions that may be incorporated into the Series; (d) if selected to be a contestant in the Series, I shall appear as myself; my appearance in the Series is not a performance, shall not constitute an employment relationship between me and Producer or the Network, shall not be subject to any union or guild collective bargaining agreement, and shall not entitle me to any wages, salary, corporate benefits, workers’ compensation benefits, or other compensation of any kind, under any such collective bargaining agreement or otherwise; and (e) my participation in the Series (if any) and the use of the Material by Producer or anyone else will not cause me to be in breach or violation of any agreements to which I am a party.

Please check the box above to indicate your acknowledgment of the eligibility requirements.

Releases and Other Terms *

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

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