TheUltimatum

First Name *

Last Name *

Partner's Full Name *

Street Address *

City *

State *

Phone Number *

Email *

Partner's Phone Number *

Partner's Email: *

Highest level of education completed? *

Please upload a photo of you and your partner *

Remove image

We have detected that you are using an unsupported browser. Please upgrade your browser.
Drop image here or
Select File

Select File

To replace the current image, just upload another image

Please provide a link to your Facebook account *

Please provide a link to your partner's Facebook account *

Please provide a link to your Instagram account *

Please provide a link to your partner's Instagram account *

Please provide a link to your Tik Tok account *

Please provide a link to your partner's TikTok account *

Do you live with your significant other? *

Occupation *

Partner's Occupation *

Do you and your partner work remote or from your place of employment? *

How many hours a week do you work? How many hours a week does your partner work? *

How long have you and your partner been together? *

How did you meet your current partner? How did you fall in love? *

What do you see the next step in your relationship being? Why? *

Have you ever temporarily ended the relationship with your partner? If so, why? *

What are your most memorable moments together? *

What do you like most about your partner? *

Describe your biggest issue within the relationship. *

How are you and your partner similar? (Personality wise, family upbringing, hobbies, interest, etc.) *

How are you and your partner different? (Personality wise, family upbringing, hobbies, interests, etc.) *

What interests/activities do you wish your partner did with you? *

What challenges are you bringing to the relationship? *

What challenges is your partner bringing to the relationship? *

What relationship changes would you like to see made? *

Do you have any relationship regrets? Please explain. *

Do you wonder if the grass is greener with someone else? How so? *

How have you tried to improve your relationship? Have you seen a therapist? Please explain. *

Why haven't you and your partner taken the next step yet in your relationship? *

If one of you were to give an ultimatum in your relationship, who would give it and why? *

Do you have any conflicts with the following dates? If so, please note below.
February 12, 2024 - April 10, 2024 *

Are you willing and able to take 2 weeks off from work and other commitments during production? *

Have you ever filmed anything for television before? If so, what and when? *

Have you applied to any other series made for television? *

Have you ever appeared on television before? If so, please list the name of the show, network, and approximate air date. *

What is your COVID-19 vaccination status? *

What is your partner's COVID-19 vaccination status? *

How did you hear about this casting? *

Personal Release - Casting Interview *

Pacific View TV, LLC. (“Producer”) 11755 Wilshire Boulevard, Suite 2000 Los Angeles, California 90025 Ladies and Gentlemen: In consideration of Producer agreeing to consider including me as a potential participant in one or more episode(s) of an “The Ultimatum” (“Program”), intended for initial exhibition on one or more third-party television network or other distributor (collectively, “Network”), and with the understanding that Producer is relying on the terms of this Release in considering me as a participant in the Program and in producing the Program, and without any further consideration due to me or any other person or entity from Producer or any third party, and with the further understanding that Producer, in its sole discretion may choose whether or not to include me in the Program, and whether or not to broadcast the Program, I hereby agree as follows: I grant to Producer the irrevocable right (but not the obligation) to film, tape, photograph, and/or record, as well as the right to exhibit, edit and otherwise use my name, likeness, voice, conversation, sounds, appearances, performances, and any information I may provide (without limitation applications, questionnaire responses and biographical data), including, without limitation, any in- person interviews, any virtual/remote interviews, phone interviews and/or other casting activities (collectively, my “Appearance”), as well as the right to exhibit, edit and otherwise use my Appearance on or in connection with the Program or otherwise in any manner in Producer’s sole election and sole discretion. I agree that Producer, its successors, licensees and assigns are the sole owner of all the results and proceeds of such film, tape, photography and/or recording(s) and my Appearance thereon (collectively, the “Materials”), with the irrevocable right, forever and throughout the universe, to use the Materials and any portion thereof in any and all media, whether now known or hereafter devised, including, without limitation, motion pictures, television and publishing, and in connection with the advertising, sale, promotion, marketing, merchandising, distribution, publicizing and any and all other types of exploitation of the Program or any part thereof or any other production. The Materials shall also include any photographs, videotapes, sound recordings, writings, drawings or other materials that I may provide to Producer (collectively, “Other Materials”), except that I will retain ownership of such Other Materials, but I hereby irrevocably and perpetually license the Other Materials to Producer for use in the same manner and to the same extent as the Materials, and other than with respect to ownership, all references to the Materials shall be deemed to include the Other Materials. I acknowledge that Producer shall have the unrestricted right to edit the Materials and the Program in any manner or form, and to place the Materials and the Program in any context or setting or use, and my release of claims hereunder shall include any claims of misrepresentation or defamation as a result of any editing, placement, context or other use or manner of portrayal of the Materials. Without limiting the foregoing, I hereby grant Producer the right to use and license others to use my name, voice, sounds, image, likeness and biographical information in and in connection with the Materials, whether as part of the Program or otherwise, or in connection with advertising, programming and publicity materials for the Program (including, without limitation, commercial tie-ins) and/or Producer, the Network and any of their respective parent, subsidiary, related entities or affiliates, sponsors of the Program, and for the institutional purposes of Producer and Network and/or their respective affiliated entities, throughout the world, in any and all media, now known or hereafter devised, in perpetuity. I recognize that Producer is relying on the terms of this Release in agreeing to consider me as a potential participant for inclusion in the Program and in producing the Program and therefore, this Release shall be irrevocable, and I shall not be entitled to terminate this Release or any of the rights granted hereunder, nor to interfere with, restrain, enjoin or otherwise impair the production or distribution of the Program. My sole remedy, in any or all cases, shall be an action at law for money damages, if any, and I specifically acknowledges that I shall not be entitled to equitable or injunctive relief, all of which I knowingly waives. I also recognize that a breach by me of this Release would cause Producer damages that cannot be adequately compensated by money damages, and I therefore expressly agrees that Producer shall be entitled to injunctive and other equitable relief to prevent and/or cure any breach or threatened breach of this Release by me. I HEREBY RELEASE, DISCHARGE, AND HOLD HARMLESS THE PRODUCER, NETWORK AND ITS RESPECTIVE SUCCESSORS, LICENSEES AND ASSIGNS (INCLUDING, WITHOUT LIMITATION, ANY RELATED OR AFFILIATED ENTITIES, ANY NETWORKS, SPONSORS AND/OR EXHIBITORS, AND THE AFFILIATES, OFFICERS, BOARD MEMBERS, DIRECTORS, EMPLOYEES, AGENTS AND REPRESENTATIVES OF ANY OF THE FOREGOING) WITH RESPECT TO ANY AND ALL CLAIMS,DEMANDS, OR CAUSES OF ACTION THAT I MAY HAVE IN CONNECTION WITH MY PARTICIPATION AS AN APPLICANT AND/OR PARTICIPANT IN CONNECTION WITH THE PROGRAM OR ANY USE OF THE MATERIALS WHATSOEVER, WHETHER IN CONNECTION WITH THE PROGRAM OR OTHERWISE, INCLUDING WITHOUT LIMITATION, CLAIMS BASED UPON DEFAMATION OR INVASION OF PRIVACY, OR ANY OTHER MATTER ARISING OUT OF OR IN ANY MANNER CONNECTED WITH THE USE AND EXERCISE OF THE RIGHTS GRANTED TO PRODUCER HEREIN. I affirm that neither I nor anyone acting for me gave or agreed to give anything of value to any member of Producer’s production staff, anyone associated in any manner with Producer, or any representative of any television network or station or sponsor in exchange for Producer agreeing to consider me for participation in the Program, and I have not accepted anything of value for inclusion of any product, service, venture or other materials in connection with my appearance either as an applicant or a participant. I understand Producer’s policy prohibits such payments or consideration, and I further understand that it is a federal offense, unless disclosed to Producer prior to broadcast, for any such arrangement or my acceptance or agreement to accept anything of value to promote any product, service or venture on the air. I am also aware that it is a federal offense to use any prepared material containing such a promotion where I know the writer received consideration for it and fail to disclose this to Producer prior to broadcast. I shall notify Producer immediately if any person attempts to induce me to violate the foregoing or to do anything that is a misrepresentation of any fact or information or to do anything in connection with the Materials that is dishonest, illegal or a breach of the terms of this Release. I understand that Producer may assign or transfer this Release and all or any part of Producer's rights under this Release to any person, firm or corporation without limitation, and this Release shall inure to the benefit of Producer and Producer's agents, licensees, successors and assigns. This Release is personal to me and may not be assigned by me and any assignment shall be null and void upon its making. I represent and warrant that (a) I am at least 18 years of age, (b) I have the full, complete and unrestricted right and authority to enter into this Release, without the consent of any other party, (c) to the best of my knowledge, my Appearance and the Other Materials will not violate or infringe upon any third party's rights (including, without limitation, any rights of publicity or privacy); and (d) I am not a candidate for any public or elected office. I understand that if I am selected to proceed in the casting process to be considered as a potential participant, I will be required to sign one or more additional agreements, which may contain the terms set forth herein with respect to my participation in the Program, as well as additional and/or different terms. I understand that I may also be required to submit to background checks, psychological examinations, and similar screenings, and that I shall be required to comply with all applicable rules and requirements relating to the Program, before I am allowed to participate in the Program. I agree that any and all information disclosed to or obtained by me concerning or relating to the Program and/or Producer shall be strictly confidential, and I hereby agrees not to disclose any such confidential information to any individual or entity by any means, including without limitation, via email, mobile/text message and/or posting on any social media platform. I shall also not directly or indirectly issue or permit the issuance of any publicity whatsoever with respect to the Program or my potential appearance in connection therewith or any of the Materials without Producer’s prior written approval in each instance. I shall keep anything confidential concerning or relating to the Program and/or Producer activities, and I shall not use the name of the Program or refer to my participation as an applicant or participant in any way at any time without Producer’s prior written approval in each instance. This Release sets forth the entire agreement between Producer and myself with respect to the subject matter hereof and may not be altered or amended except in writing signed by both parties. This Release is binding upon me and my heirs, representatives, agents, employees, successors, licensees, and assigns. This Release may be executed in counterparts and transmitted by secured digital or electronic transmission, which shall constitute an original and, when taken together, shall constitute a single instrument. This Release shall be governed by and construed in accordance with New York law as if this Release were executed and performed fully in the State of New York, regardless of where execution and performance hereunder may actually occur.

By checking this box and signing below, you each individually agree to the above terms.

Partner #1 Signature *

Clear

Use your mouse or finger to sign above

Type Your Full Name

I hereby warrant and represent that any information I have provided herein is correct, truthful and accurate. BY SIGNING BELOW, I ACKNOWLEDGE I HAVE READ, UNDERSTAND, AND AGREE TO THE TERMS OF THE FOREGOING PERSONAL RELEASE.

Partner #2 Signature *

Clear

Use your mouse or finger to sign above

Type Your Full Name

I hereby warrant and represent that any information I have provided herein is correct, truthful and accurate. BY SIGNING BELOW, I ACKNOWLEDGE I HAVE READ, UNDERSTAND, AND AGREE TO THE TERMS OF THE FOREGOING PERSONAL RELEASE.

For All Potential Participants, a Must Read: *

Kinetic Content and its subsidiaries (“Kinetic”) produce a wide variety of content in various genres, including some of the most popular series on the planet. Our content is enjoyed by tens of millions of people worldwide, and tens of thousands of people have applied to participate in our programs. We’re incredibly proud to have featured an extraordinary variety of Participants across our shows, representing tremendous diversity of age, ethnicity, experience, socio-economic status, background, identity, sexuality, heritage, physicality, beliefs and point-of-view. We’re passionate about people and their stories, both on and off screen, and we support a culture of inclusivity and creativity. Participating in one of our programs can be an incredibly positive, memorable, and rewarding experience. However, no one should ever consider participation in one of our programs if they do not completely understand, acknowledge, and willingly accept the parameters and requirements of the applicable program, and we strongly encourage anyone who is interested in participating to contemplate the possible discomfort and emotional challenges they may face before, during, and after filming. Potential Participants should discuss the possible implications of participating – many of which are discussed below - with their family, friends, advisors, counselors, coworkers, and/or bosses (when applicable) to ensure they feel participation is right for them. OUR PARTICIPANTS Most of the people who participate and appear in our programs are not trained actors, and participation in our programs is not a job, nor a career. Our participants could be your friends, family members, or neighbors, who have their own full lives, careers, friends and families to which they will return, hopefully enriched by a once-in-a lifetime experience. Whether Participants choose to participate in one of our productions in order to pursue a dream, showcase their skills, look for love, solve a puzzle, or just express who they are, the choice to participate is theirs and theirs alone – and we are honored to have the chance to be alongside them helping share their stories with the world. THE RIGHT FIT DEPENDS ON THE RIGHT INFORMATION Participating in one of our programs can be challenging. Participants may be immersed in new environments and exposed to new circumstances, and where possible, we encourage all Potential Participants to watch previous seasons of the series which they are applying for participation. It is imperative that applicants know themselves and what will be expected of them before submitting an application to participate. It is extremely important for applicants to be truthful and honest when providing information throughout all stages of the Casting and Diligence Process (discussed below), including on questionnaires or assessments and when communicating with casting team members, evaluators, and producers. Applicants must disclose, in advance, any issues or conflicts of any kind that may prevent them from wholly fulfilling their obligations. All applicants must also disclose in advance any personal care items they may require during their time with us, including but not limited to prescription medication from a licensed healthcare professional. Kinetic expects all applicants to be honest, and evaluate and prioritize their comfort, mental health, and well-being, above the opportunity to participate in a program or appear on TV. PARTICIPANT AGREEMENTS Applicants who advance in the casting process for any program will be presented with written agreement(s) with the entities involved in the production, setting forth the terms and conditions of being a Participant. Applicants should thoroughly review these documents, and ensure they understand the terms and requirements of the agreement(s) and the production, prior to committing to participate. If Applicants have any questions, they are encouraged to ask questions of casting team member(s), or producer(s) as appropriate. Before signing any agreement(s), all Applicants are encouraged to seek the advice of legal counsel of their choosing. These agreement(s) must be signed before the Diligence Process (discussed below) or participating in filming for the production (as applicable) begins. Kinetic, its affiliates, subsidiaries and third-party teams expect that those who choose to participate fully understand, acknowledge and will live up to the promises and terms to which they have agreed. DILIGENCE PROCESS For many productions, the casting and selection phase requires a diligence process that can include background investigations, psychological evaluations (not limited to mental health assessments and testing), and even medical assessments to assess an applicant’s fitness for a particular production. During the diligence process, Kinetic works with licensed, experienced, and vetted third-party vendors. Applicants’ interactions with mental health professionals through the diligence process do not constitute therapy or mental health services or create a psychotherapist/patient privilege. The results of any evaluations, testing, and investigations during this process are carefully reviewed to determine whether an individual is appropriate for selection as an on-camera Participant. There are many reasons why an applicant might not be a fit for a particular production. And although Kinetic strives to find a fit, our Diligence Process is only as good as the information we receive. Once again, it is extremely important for applicants to be truthful and honest when providing information throughout all stages of the Diligence Process, including on questionnaires or assessments and when communicating with casting team members, evaluators, and producers. Kinetic, its affiliates, subsidiaries and third-party teams cannot accurately evaluate fitness unless applicants are completely honest and forthcoming. Kinetic cannot avoid a potential problem if relevant information is not disclosed. Likewise, Kinetic cannot remedy an undisclosed or minimized existing problem. PRODUCTION Each of our productions are unique, and regardless of the size and scope of the production, we ask all our Participants to remember that the people on our crew work hard to make each Participants’ experience as pleasant as possible. Kinetic strives to ensure all Participants, employees, and production crew are treated equally, respectfully, and fairly. Participating in any of our programs is intended to be exhilarating and rewarding. However, Participants need to be aware they may experience potential real-life challenges, encounter highly emotional and stressful situations, be subjected to negative opinions from others, and face decisions that have real-life and unpredictable consequences. Some of our programs require conditions that may make some people uncomfortable. However, these conditions are often critical to the integrity of the format of the programs. For example, Participants may be sequestered for a period of time or have no access to phones, TV, the internet, or other means of outside communication. On some shows, bathroom and meal breaks may be monitored or chaperoned. On many shows, Participants must bring any pre-disclosed prescription medication necessary to the production location; Kinetic cannot be responsible for filling or dispensing prescriptions of Participants. Kinetic will inform Participants of these types of circumstances before they agree to participate in a program. It is important for Participants to remember that they have been both informed of, and agreed to those conditions and requirements prior to participating. Each Participant must plan, take individual responsibility, and communicate. Kinetic takes any concerns or complaints very seriously, whether from our Participants, our production team or our employees. Anyone who participates in our productions should immediately communicate any concerns or potential issues that may arise at any phase of the production process, regardless of whether the issue involves you (the Participant), another Participant, team member, or employee. Kinetic cannot address issues of which it is unaware or which are trivialized. POST FILMING EXPECTATIONS After filming has “wrapped,” there may be a lengthy delay of months or even years until the program airs. Sometimes, on rare occasions, a program may never air. Kinetic will strive to inform Participants, as appropriate, when a program may air. Still, we are a production company and not a network, broadcaster, platform, or distributor, so these decisions are not something Kinetic controls. Participants may feel uncertain during this period, and emotions can vary depending on each individual’s experience. For instance, it may be difficult to manage the potential disappointment of unsuccessful romantic connections and the potential negative feedback from social media platforms. Please reach out to us and take advantage of our dedicated talent support team, and speak to your personal support network (family, friends, counselors, therapists, etc.) at this time. Kinetic strongly encourages all Participants to seek and arrange individual professional mental health support services post filming, not limited to counseling and therapy. WATCHING THE SHOW For some Participants, the prospect of seeing themselves on TV can be exciting. For others, it can be extremely daunting. Some Participants may feel self-conscious or find it odd to see themselves on TV. It can be difficult to be reminded of deeply personal and emotional life events, and see them replayed in public. Participants may be upset to be the subject of negative opinions from other Participants or the public, or may be unhappy with the way they feel they have been portrayed. For many programs, including our social experiments and relationship programs, we film thousands and thousands of hours of footage each season to make a 10–12 hour show. It’s therefore obvious that each Participant’s personal experience will be broader than the edited version seen on TV. And sometimes, a Participant will recollect events incorrectly or differently than how they appear on the show, no matter how accurate the overall portrayal. Some people participate in our programs and are unhappy about how much (or how little) “airtime” they receive. They may be surprised to find that moments they felt were important - and sometimes even their entire story - have been left out of the finished program. But, of course, Kinetic cannot and does not guarantee that participating in one of our programs will result in on-air exposure. TRADITIONAL AND SOCIAL MEDIA While there are many potential positives to appearing on TV, there are also potential downsides. Sudden public scrutiny can be unpredictable and also lead to unwanted intrusion into a Participant’s life, including their past, their friends and family, and their social media activity. People who claim to know a Participant may provide information (true or not) to the press and/or post it to social media. On-camera actions may be analyzed, critiqued, or mocked. Even if a Participant is well-versed in social media and enjoys interacting online with strangers, toxic social media “trolling” – often by completely anonymous accounts – may result from their participation in a program. Remember, being in the public eye can make you a target for many untruths, half-truths, or mischaracterizations of the truth. Obviously, Kinetic cannot control comments that are made about our Participants in the press or on social media – whether negative or positive. Participants should try to manage their expectations as they navigate the potential ups and downs of the attention they may receive on social media. All Participants are required to enter into a strict confidentiality and non-disclosure agreement prior to participating in any program. Any breach of the agreements on social media or otherwise will result in immediate action, including legal action, when required. Participants are strongly advised to review their agreements before posting, even if it is in response to another post. Remember that social media is not real life, and the opinions of trolls should not be viewed as real. Sometimes the simplest thing to do is to take a break. Your own well-being and mental health are far more important than the number of “likes,” followers, or what people say about you. Please speak to your loved ones, a mental health provider, our dedicated talent support team, or utilize your personal support network if trolls affect your confidence, self-esteem, or mental health. ADDITIONAL RESOURCES Resources on this page are provided for informational purposes only. The list is not comprehensive and does not constitute an endorsement by Kinetic Content, LLC., its partners or its related or affiliated entities. * Call 911 if you or someone you know is in immediate danger or go to the nearest emergency room. * To connect with mental health resources near you, visit the National Alliance on Mental Illness (NAMI) website or call 1-800-950-6264. If you or someone you know has a mental illness, is struggling emotionally, or has concerns about their mental health, there are ways to get help. * CalHOPE partners with California Mental Health Services Association which has a statewide experienced workforce comprised of peers, community mental health workers, and other non- licensed personnel. Individuals in need of emotional and/or crisis support can receive “visits” by phone, videoconference, smart device, or computer chat. Depending upon needs and situation, family and/or group support sessions are also available. Individuals also may be connected to county-based services. * 988 Suicide & Crisis Lifeline. The Lifeline provides 24-hour, confidential support to anyone in suicidal crisis or emotional distress. Call or text 988 to connect with a trained crisis counselor. Call or text 988; Use Lifeline Chat on the web (English only.) By checking the box and signing below, I acknowledge that I have received and read this document; and that I shall not directly or indirectly issue or permit the issuance of any publicity whatsoever with respect to the subject matter contained within this document, not limited to the program, producer, network or my appearance in connection therewith without producer’s prior written approval in each instance. I shall keep anything confidential that I may learn about the program, and I shall not use the name of the program or refer to my participation as an applicant or participant in any way at any time without prior written approval in each instance.

Participant #1 Signature: By signing below, I acknowledge that I have received and read the letter to all potential participants in point 53. *

Clear

Use your mouse or finger to sign above

Type Your Full Name

Participant #2 Signature: By signing below, I acknowledge that I have received and read the letter to all potential participants in point 53. *

Clear

Use your mouse or finger to sign above

Type Your Full Name

TODAY'S DATE: *

Please Select