First Name *
Last Name *
Birth Date: *
Are you a US Citizen? *
Current City *
Current State: *
Email Address: *
What is your occupation?
What is your weight?
What religion do you practice (if applicable)?
What is your ethnicity?
What is the highest level of education you completed?
Current relationship status: *
Please upload a recent photo (Please be sure we can see your face clearly). *
How did you find us? *
How did you meet your Co-Parent?
How long have you been planning a child with your Co-Parent?
Why did you choose this person to Co-Parent with you?
Are you/your Co-Parent currently pregnant? If yes, what trimester are you in?
If you/your Co-Parent are not currently pregnant, where are you in the Co-Parenting process in regards to exploring pregnancy options?
Do you live with your Co-Parent? What are the current living arrangements?
List five (5) qualities you want in a Co-Parent.
Is religion important to you? If yes, what is your religious preference?
What qualities are deal breakers in a potential Co-Parent, if any? E.g. smoking, height, education level, etc.
What three (3) things must you and your Co-Parent see eye-to-eye on in regards to how you raise your child?
Why is being a Co-Parent important to you?
What was your “Ah-ha!” moment when deciding to become a Co-Parent?
What are the advantages of Co-Parenting over raising a child on your own?
What do you want/expect from your partner in a Co-Parenting relationship?
What excites you about Co-Parenting?
What reservations do you have, if any?
How does your family feel about your decision to pursue a non-traditional family with a Co-Parent?
Why do you think it’s important to share your Co-Parenting story?
Why are you ready for a child now?
Why are you choosing to raise a child with a Co-Parent instead of waiting to find a romantic partner?
Please use the space below to expound on anything you feel we should know about you that was not covered above.
Has your Co-Parent already filled out a separate application for themselves?
Terms and Conditions *
Terms and Conditions
I hereby acknowledge,
Irrevocably and absolutely grant permission and right to Kinetic Operations, LLC, its parent, affiliates, subsidiaries, successors, assignees and licensees (collectively “Producer”) to use and share the information I have supplied (“Material”) in connection with the casting of Producer programs (“Program”). I hereby acknowledge that Producer shall have no obligation to utilize my name or any Material in the Program or in any other Producer programs or in any other media. I hereby further acknowledge that my submission of Material does not mean that I have been selected to participate in the Program, or that Producer has any rights or obligations towards me or the Material I have supplied.
I confirm that any statement made, written or submitted by me in connection with the Program will be true and will not violate or infringe upon any third party’s rights. I further warrant that Producer’s exercise of the rights contained herein shall not violate or infringe any rights of any third party. I understand that Producer has been induced to proceed with casting the production of the Program at Producer’s great expense, time and effort, in reliance upon my consent to this agreement and that accordingly this agreement shall be irrevocable.
I understand and agree that during my participation in the selection process, I may be exposed to unusual, uncomfortable and extremely emotional situations, which may include, without limitation, surprising, humiliating, insulting, and mentally stressful circumstances, as well as positive and/or negative public opinions. I, with full knowledge of the foregoing voluntarily agree to participate in the selection process of the Program, with full knowledge, appreciation and understanding of the direct or indirect psychological ramifications involved and hereby agree to accept any and all risks of participating in the Program. I acknowledge that my ongoing participation throughout the selection process of the Program is voluntary; provided, however, that any choice not to participate shall not affect any of the rights assigned by me or any of the covenants, agreements, waivers, releases or indemnities made by me
in this agreement.
I understand and agree that I shall keep in strictest confidence and shall not disclose to any Program participant, or other third party at any time any information or materials of any kind that I know, hear or otherwise acquire or learn about the Program, or in connection with or as a result of my submission in the Program, concerning or relating to Producer, the Program, including but not limited to the nature of the Program, or the Program participants. I understand and agree that any discussion will be considered defrauding the Producer. I acknowledge that such a discussion and/or revelation or any other breach of this agreement would cause Producer 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 shall be entitled to, (but in no way limited to) injunctive and other equitable relief as well as money damages 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 in the event that I breach this paragraph will be costly, difficult, or impracticable to calculate or ascertain with certainty or specificity, the calculation of which to be determined by a court of competent jurisdiction.
I acknowledge that all rights in and to the Material shall be Producer’s sole and absolute property. I also understand that my submission, potential appearance in the Program or participation in the production of the Program is not and will not be deemed employment or an engagement to perform any services and there will be no payment due in connection with the use of the Material. Notwithstanding the foregoing, in the event and to the extent the Material or any portion thereof is not deemed a “work made for hire”, such will not affect the rights herein granted above, and I hereby assign all of my rights, if any exist (including copyright) in the Material and any portion thereof to Producer, without reservation.
I hereby agree to defend, indemnify and otherwise hold Producer free and harmless from and against any and all claims, demands and expenses (including reasonable outside attorney’s fees) arising out of or resulting from my submission or any information or statements I have supplied in my submission to Producer.
I hereby agree not to sue and irrevocably and unconditionally remises, releases, waives and forever discharges Producer, its parent and related companies, subsidiaries (whether or not wholly-owned), affiliates, divisions, licensees, and their past, present and future officers, agents, representatives, employees, successors and assigns, jointly and individually (hereinafter collectively referred to as “Releasees”), from any and all manner of liabilities, claims, causes of action, debts, liens, obligations, costs, expenses, accounts, losses 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 has, or in the future may have against the Releases arising out of or related to the conduct and/or uses described herein, including, but not limited to any and all claims for invasion of privacy (including without limitation publication of private facts, intrusion into seclusion, false light, and infringement of my common law and/or statutory right of publicity), defamation (including libel and slander), infliction of emotional distress, fraud, trespass, breach of any alleged contract, allegedly deceptive, unfair and/or fraudulent business or trade practices and any other claims of personal and/or property rights.
Although I agree not to bring any claim in connection with the Program or any element thereof, or any advice, treatment or therapy received or provided, including but not limited to such claims and causes of actions set forth above, if any claim is made, I agree that this agreement shall be construed by and governed in accordance with the laws of the State of California and that, with respect to any dispute arising from this agreement, sole and exclusive jurisdiction and venue shall lie with the state and federal courts located in the County of Los Angeles, State of California.
This agreement contains our entire understanding relating to the subject matter contained therein and cannot be changed, modified or terminated except by an agreement signed by both parties. I acknowledge that no other party, nor any agent or attorney of any such party, has made any promise, representation or warranty whatsoever, express or implied, not contained in this agreement, to induce them to execute this agreement. I further acknowledge that I am not agreeing to the terms of this agreement in reliance on any promise, representation or warranty not contained in this agreement. This agreement shall be binding on all parties, their heirs, successors, licensees and assigns. Producer may freely assign its rights and obligations hereunder as it deems appropriate.