Produced by: theoldschool (www.theoldschooltv.com) (“Producer”)
An adult (legal guardian) 12+ must apply on behalf of a minor.
1. You must be a legal US resident.
2. You must be legally authorized to live and work in the United States on the Program, or you are in the process of attempting to obtain lawful authorization so that you will be able to legally live and work in the United States on the Program by the time pre-production begins on or around August 29, 2021.
3. You are not currently, nor do you currently intend to be, a candidate for public office, and if there is any change in this representation prior to the initial exhibition of the program in which you appear, you must immediately notify Producer at email@example.com. Becoming a candidate before or around the time of the initial exhibition of the Program may under certain circumstances have legal implications on the exhibitor’s ability to exhibit the Program.
4. You and your immediate family and household members must not be an employee, officer or director of Producer, Warner Horizon Television (“Network”) or any of their respective affiliate companies, parent companies, subsidiaries, advertising agencies or any person or entity supplying goods or services for the Program. In addition, Producer and Network reserve the right to render ineligible any person that Producer and/or Network determines, in their sole discretion, is sufficiently connected with the production, administration, judging, or distribution of the Program such that his or her participation in the Program could create the appearance of impropriety. Please disclose any such relationships here (if none, write “none”):
If applicant is a minor, please list the name and relation of the person filling out this form:
a. If I am submitting this questionnaire on behalf of a minor, I represent and warrant that I am the minor’s parent or legal guardian.
First Name *
Last Name *
Date of Birth *
Current Address: *
Which Hogwarts house do you belong to? *
Are you available September 2 & September 4, 2021 inclusive to film in Los Angeles? *
Have you received a complete dose of a COVID-19 vaccine (e.g., one shot for the Johnson & Johnson vaccine, two shoots for the Moderna and Pfizer vaccines, etc.)? *
Date(s) of vaccination (you will be required to submit proof of vaccination to be considered for participation). *
Please upload a photo of yourself * *
By signing below, you acknowledge that information regarding your vaccination status will be treated as confidential by Producer and used and disclosed only to the extent necessary for Producer to protect the health and safety of everyone participating in the production. Producer will comply with any and all privacy laws that may be applicable to the gathering and use of your vaccination status and related records; however, you acknowledge that Producer is not a “covered entity” under HIPAA
If you are selected as a potential participant you must execute waivers and release agreements required by Producer and Warner Horizon Television or any of their licensees, successors or assigns.
Please Check this Box and Sign and Date Below: *
Please Sign Below *
Date Completed & Signed: *