Application Form

Name:________________________

Address: ______________________

______________________________ Home Phone: __________________

Work: _________________________

Cell: __________________________

Email: _________________________

Age:

Current occupation:

Are you currently married? Yes___ No___

If so, what is your spouse's name and age? ______________________________

If so, what is your spouse's occupation? _________________________________

Names and ages of children: _________________________________________

_

What are the three main areas of your child/children's behaviour you would like help
with?

What is the worst thing that they have done in the last week?:

How did you hear about the show/casting call? ___________________________

Eligibility Requirements:· Parents must be 21 years of age.·

You must be a legal U. S. Resident.·

You must not be a candidate for elected public office and, if selected as a participant, will not become a candidate for elected public office until twelve months after the initial broadcast of the last episode in which you appear.· You must never have been convicted of a felony and have never had a restraining order or other injunctive relief entered against you. There must not be any outstanding criminal warrants against you.·

You must be willing to submit medical information to the production and submit to a medical examination, psychological examination, and background check. ·

Neither you nor any of your immediate family members (spouse, ex-spouse, parents, siblings, children) and household members (whether related or not) may be employees, officers, directors, representatives or agents of American Broadcasting Companies, Inc., The Walt Disney Company, Ricochet South Ltd., known sponsors of the Series or their advertising agencies, any station initially airing the program, and/or any of their respective parent, subsidiary, or affiliated companies, licensees, partners and assigns.

All participants must provide the following documents when submitting the Participant Questionnaire. Failure to do so will result in delaying the processing of your Participant Questionnaire and/or may result in eliminating you from further consideration:

Recent Photograph

Photocopy of Current Drivers License

I acknowledge that all of the information provided on this questionnaire is true and accurate, and any false or misleading information submitted herein is grounds for my immediate elimination from consideration. This questionnaire and any other material submitted by me including, but not limited to, pictures, film and videotapes, becomes the property of Ricochet South, Ltd. ("Producer") shall not be returned, and may be used in any manner in all media, worldwide, in perpetuity, as further set forth below. I acknowledge that Producer may determine in its absolute discretion whether or not to select me to participate in the Series and that Producer has the right to end the casting process at any time for any reason.

For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I hereby consent to the recording, use, reuse, transmission, exhibition, broadcast and other exploitation in whole or in part and in any language of my voice, actions, likeness, name, appearance, biographical material, and any information contained in this or any other application to be a participant in the Series or in any materials submitted by me in connection with my application (collectively "Likeness") by Producer, American Broadcasting Companies, Inc., The Walt Disney Company, Ricochet South, Ltd., known sponsors of the Series or their advertising agencies, any station airing the program, and/or any of their respective parent, subsidiary, or affiliated companies, licensees, partners and assigns and the officers, directors, employees, agents and representatives of any of them (jointly and severally, "Releasees") by any means and in any medium now known or hereafter devised throughout the universe in perpetuity. Releasees shall own exclusively all right, title, and interest (including, without limitation, all copyrights) in and to any written, spoken, videotaped or other materials that I have provided or may provide to Releasees in connection with my application, the Series, or otherwise (collectively, the "Materials") including, without limitation, the right to edit, alter or modify the Materials. Releasees shall have the exclusive, perpetual right to use and to assign to third parties, including without limitation any broadcaster or exhibitor of the Series, the right to use my Likeness and the Materials in and in connection with the Series and/or other programs, any promotion, publicity, marketing or advertising for the Series and/or other programs by any means and in any medium now known or hereafter devised, in commercial tie-ins, for informational purposes and/or for general advertising and promotional purposes. I grant the rights hereunder whether or not I am selected to participate in the Series. I agree to release, defend, indemnify and hold harmless Releasees from any and all claims, actions, lawsuits, liabilities and expenses (including reasonable attorneys fees) arising out of or relating to the Series application and selection process and/or the recording or use of my Likeness and/or the Materials. I agree not to make any claim against Releasees as a result of the Series application and selection process and/or the recording or use of my Likeness and/or the Materials (including, without limitation, any claim that such use is defamatory, inflicts emotional distress or invades any right of privacy and/or publicity). I understand that I will not be paid any money for giving Releasees these rights, or for signing this agreement. I agree to sign such other and further authorizations, releases or other documents as Producer deems necessary. Without limiting the foregoing, if I am selected to appear in the Series, I will execute a Participant Agreement and such additional releases and authorizations that the Producers may request, including such provisions as are customary for Producer's agreements of that type.

By signing this application, I represent and warrant that I meet and will meet all of the Eligibility Requirements, that all of the information in this questionnaire is true and accurate and that I agree to all of the terms and conditions set forth above.

Signature: ______________________________________ Date: _______________

Fill out and SIGN this application.