I, _______________________________________ hereby acknowledge that: I have answered the previous questions honestly and accurately; I will immediately inform the producers of the promotion and if any information I have provided becomes false or incomplete, or if any of the above information is found to be false or incomplete, this will be grounds for dismissal from the participant selection process, and/or from the promotion currently entitled “Smile Makeover” promotion, if selected; even if I meet the above eligibility, the producers have no obligation to interview me, and/or select me as a participant. All decisions by the producer concerning selection of the participants are final and not subject to challenge or appeal and the producers are under no obligation to return any materials submitted by me as part of the application whether or not I am selected as the participant.

I understand the promotion involves a “Smile Makeover” of the participant, which may include up to a $10,000 value of any dental cosmetics (veneers, teeth whitening, crowns, contouring, etc.). I acknowledge that before participating in the promotion I will consult with my own physician and/or dentist regarding the advisability from a physical and emotional health perspective of my potential participation in the promotion. I represent that if I proceed with the participant selection process and am selected to be a participant in the promotion, I know of no reason, following consultation with my own physician, why I should not participate in the “Smile Makeover.”

By submitting this application I hereby consent to the recording, use and reuse by the producer, and any of their respective licensees, assignees, parents, subsidiaries, or affiliated entities, hereafter referred to collectively as Producer and each of their respective employees, agents, representative, officers and directors of my voice, actions, likeness, name appearance, biographical material, and any information contained in my application to be a participant in the “Smile Makeover” or in any materials submitted by me in connection with my application as edited, altered, or modified by the releasees, in any and all media now know or hereafter devised, in any and all versions, worldwide in perpetuity, in or in connection with “Smile Makeover.” I agree the Producer may use all or any part of my Likeness, and may alter or modify it regardless of whether or not I am recognizable. I understand that I will not be paid any money for giving Releasees these rights, or signing this agreement.

I authorize the producer and its designees to investigate, access and collect information about me, about any of the statements made by me in my application.

I agree to undergo to the extent permitted by law and at the sole discretion of the producer, a dental examination requested by the producer in connection with my possible selection for and participation in the Smile Makeover. Such examination will be conducted by medical personnel of the producer’s choosing. I acknowledge that I may not be selected to participate or my participation may be discontinued at any time if in the sole and exclusive discretion of the producer and /or its medical experts the results of such tests indicate that I am not physically or mentally fit to participate in the Smile Makeover.

I agree to treat all information and material I receive or acquire as part of my participation in the participant selection process for the Smile Makeover as strictly confidential, and will not disclose any such information to any third party. I specifically acknowledge that the financial value ($10,000) of the Smile Makeover to the producer depends on confidentiality and I agree to be responsible for any and all damages, including consequential damages that the producer may suffer if I breach the confidentiality provision.

I agree to release, defend, indemnify and hold harmless the Releasees and all media and production companies affiliated with or associated with the Smile Makeover and their respective employees, agents, officers and directors from and against any and all claims. Actions, lawsuits, liabilities and expenses arising from or relating to: (a) my participation in the Smile Makeover including, without limitation, the participant selection process, (b) the use of my likeness and / or the Materials, (c) any of my acts or statements relating to or in connection with the Smile Makeover; and (d) any breach of my representations of warranties herein. I acknowledge that I may hereafter discover claims in addition to the ones released herein, and I hereby release the Producer for any such unknown or unsuspected claims. I acknowledge that I may hereafter discover claims in addition to the ones released herein, and I hereby release the Producer from any such unknown or unsuspected claims.

I acknowledge that in the event of a breach of this Consent and Release by the producer or any third party, the damage, if any, caused by me will not be irreparable or otherwise sufficient to entitle me to seek injunctive or other equitable relief. I acknowledge that my rights and remedies in any such event will be strictly limited to the right, if any, to recover damages in an action at law, and I acknowledge and agree that I will not have the right to rescind this release or any of the Producer’s rights hereunder, nor the right to enjoin the production, exhibition or other exploitation of the Smile Makeover, or any subsidiary or allied rights with respect thereto, or any other results and proceeds hereunder.

I acknowledge that any subsequent dental care past the Smile Makeover is the responsibility of the participant and not the producer.

I have read, understand, and agree with the foregoing application.