Fear Factor Casting

Extended Application Instructions Fear Factor

1.

Please fill out the extended application legibly. Print it out and handwrite it.

2.

Use dark colored ink.

3.

Answer all questions honestly and to the best of your ability.

4.

Please write only on the printed side of the paper, but feel free to attach additional sheets if necessary.

5.

Complete and return this application ASAP, as we have a very limited amount of time until production begins.
PLEASE, take your time and answer completely.

6.

When you have completed the application, send it in TOGETHER with your videotape.

FEAR FACTOR CASTING

1149 N. Gower
Suite 105
Los Angeles, CA 90038
7.

Please make sure to include enough postage when you return this package.

The Application Begins on the Next Page

Thank you for your time and effort, GOOD LUCK!

Season 6 Contestant Application

Name: ___________________________
Nickname:________________________
Phone:___________________________
Cell/Pgr:_________________________
2nd Phone:________________________
Work:___________________________
Email:___________________________
Birthdate:________________________
Social Security #: _________________

Age:__________
Current Address:______________________
____________________________________
Permanent Address:____________________
____________________________________
I check my email often: Y/N
Hometown:__________________________

How did you come to Fear Factor?:

I was approached by ___________________________________ from the Fear Factor Casting Staff at
____________________________________________________________________________________
I sent in a video tape
I went to an Open Call in ______________________________________________________________
Other (please explain): ________________________________________________________________

Part I: About Me
1) Who is your current employer and occupation? (What job pays your bills now?)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
2) What levels of education have you completed (please specify school and major):
High School, Some College, Professional Degree, Bachelors Degree, Masters Degree, Doctorate.
School(s):
Major(s):
Year Graduated:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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3) What is the next milestone in your life if you do not make the show?
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4) Do you work out? If so, what types of activities and how often? (Be as specific as possible)
_____________________________________________________________________________________
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5) What sports organizations have you been a member of? (i.e., High School; College; Minors;
Professional; etc..., please list all that apply and the levels played)

_____________________________________________________________________________________
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6) Please circle those that apply: Married, Divorced, Boyfriend/Girlfriend, Single, Engaged
How long have you been in your current relationship?
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7) What would your friends say are your best qualities?
_____________________________________________________________________________________
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8) What would your friends say are your worst qualities?
_____________________________________________________________________________________
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9) What magazines/newspapers do you read?
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10) How are you competitive in your every day life?
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11) What do you think was the scariest stunt on a previous Fear Factor?
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12) What pets do you own now, or have owned at any time in the past?
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13) Have you had any experiences that have traumatized you? If yes, please explain:
_____________________________________________________________________________________
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14) What is your unique and personal motivation for wanting to compete on the show?
_____________________________________________________________________________________
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15) How would you use $50,000 in Fear Factor winnings?
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16) Who do you live with and for how long?

_____________________________________________________________________________________
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17) Please list your last three jobs:
1.___________________________________________________________________________________
2.___________________________________________________________________________________
3.___________________________________________________________________________________
18) Do you have any military experience? Are you (active /reserve) military now? (Circle one) If so,
please describe branch, rank, job, and dates of enlistment:
_____________________________________________________________________________________
_____________________________________________________________________________________
19) What conversation topics are "off limits" for you at a dinner party?
_____________________________________________________________________________________
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20) What is the most daring and dangerous thing you have ever done? Describe the circumstances:
_____________________________________________________________________________________
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21) If you were going to be in People magazine, what inside info about you would be put up next to your
picture?
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22) Describe your most embarrassing moment:
_____________________________________________________________________________________
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23)What is the weirdest thing about you?
_____________________________________________________________________________________
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24) If you had Aladdins lamp and 3 wishes, what would you wish for? (Rule: you cant wish for money
or more wishes).
1.___________________________________________________________________________________
2.___________________________________________________________________________________
3.___________________________________________________________________________________
Why?________________________________________________________________________________
_____________________________________________________________________________________
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25) What is your strategy to win the game? (We wont tell the others.)
_____________________________________________________________________________________
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_____________________________________________________________________________________
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THIS SEASON 95% OF OUR SHOWS WILL BE WITH PAIRS! IT WILL GREATLY INCREASE
YOUR CHANCES IF YOU FILL QUESTION #28 OUT COMPLETELY!

28) Do you know any of the following that may be interested in trying out for the show?
TYPE:
Twin Brother or Twin Sister
Brother or Sister
Boyfriend or Girlfriend
Wife or Husband
Ex-boyfriend or Ex-girlfriend
Best Friend
11-13 or 17-19 year-old child
Other:

NAME/NUMBER:

29) What do you fear? Circle a number 1-5. How much do you fear...
1=No Fear

3=Dislike

5=Cant Stand

Comments

Falling

1 2

___________________________________

Sharks

1 2

___________________________________

Rodents/Rats

1 2

___________________________________

Flying Insects

1 2

___________________________________

Eating Live Animals

1 2

___________________________________

Closed in Spaces

1 2

___________________________________

The Boogie Man/Night Crawlers

1 2

___________________________________

Dogs/Cats

1 2

___________________________________

The Ocean

1 2

___________________________________

The Dark

1 2

___________________________________

Blood

1 2

___________________________________

Spiders

1 2

___________________________________

Heights

1 2

___________________________________

Cockroaches

1 2

___________________________________

Germs/Cooties

1 2

___________________________________

Drowning

1 2

___________________________________

Fire

1 2

___________________________________

Flying

1 2

___________________________________

Lakes

1 2

___________________________________

Big Wild Animals

1 2

___________________________________

Bugs

1 2

___________________________________

From the above list please circle your 3 biggest fears.

30) How much skill do you have at...? (Be honest)
1= Never Done it 3/4/5 =Recreational 7=World Class

1 2 3 4 5 6 7

Comments

Base Jumping

____________________________________

Being Bratty

____________________________________

Bungee Jumping

____________________________________

Casino Gambling

____________________________________

Cliff Diving

____________________________________

Contact Sports/Collisions

____________________________________

Gymnastics

____________________________________

Hangliding

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High Diving

____________________________________

Manipulating People

____________________________________

Motorcycle Riding

____________________________________

Risky Behavior

____________________________________

Rock Climbing

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Rollerblading

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Rope Climbing

____________________________________

Scuba Diving

Are you certified?_____________________

Skiing

____________________________________

Skydiving

____________________________________

Snowboarding

____________________________________

Strategizing for Personal Gain

____________________________________

Street Fighting

____________________________________

Surfing

____________________________________

Tempting the Opposite Sex

____________________________________

Eating Unusual/Rare Cuisine

____________________________________

Whitewater Rafting

____________________________________

Working Out

____________________________________

________________________

____________________________________

________________________

____________________________________

________________________

____________________________________

Part II: My Background Information

1) Have you ever been treated for any serious physical or mental illness(es) or had any serious injuries?
Yes_______
No_______
If yes, please describe in detail, citing dates, diagnosis and any on-going problems:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
2) Are you on any medication that you must take on a regular basis?
Yes_______

No_______

If yes, please describe in detail:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
3) Do you have any allergies?
Yes_______

No________

If yes, please describe in detail:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
4) Have you ever been treated for stress-induced asthma, heart conditions, or high blood pressure?
Yes_______

No_______

If yes, please describe in detail, citing dates, diagnosis and any on-going problems:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
5) By law, you must list all television shows that you have appeared on (reality, game show, scripted etc.).
Even if you did not win anything, you must disclose all television appearances.
Show
Network
Approximate Air Date
Role in Show
Prizes Won
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

6) Have you ever written, contributed to, been interviewed or written about in any magazine or newspaper
article, radio or television program, internet site, or any other print or media?
Yes_______
No_______
If yes, please describe your involvement:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
7) Have you been asked by any individual or entity to submit this application?
Yes_______
No_______
If so, describe in detail that request and any compensation you may receive if you are chosen to appear on
the show or participate in the application process.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please list below, to the best of your knowledge, anyone you know or have known who is now, or has
been in the past two years, an officer, employee, agent or representative of:
(a)
National Broadcasting Company, Inc. (NBC), its licensees, assigns, parent
(General Electric Co.), or affiliated or subsidiary companies (e.g., NBC Studios, Inc.) or any affiliated
television station, or any television station or channel that broadcasts the Program.
(b)
Pulse Creative, Inc., Lock and Key Productions, Endemol Entertainment USA, Inc.
or any of their respective licensees, assigns, parents, or affiliated or subsidiary companies or any other
person or entity involved in the development, production, distribution or other exploitation of Fear Factor
or any variation thereof.
(c)

Any sponsor of Fear Factor or its advertising agency.

(d)

Any person or entity supplying prizes or services to Fear Factor.

OR CHECK THIS BOX

NO. I do not know or have known anyone who fits these categories.
_____________________________________________________________________________________
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_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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Have you ever been charged with any crimes, including a misdemeanor or a felony?
If yes, please explain briefly:

NO

YES

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Have you ever been convicted of any crimes, including a misdemeanor or a felony?
If yes, please explain briefly:

NO

YES

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Have you ever had a temporary or permanent restraining order against you, or an application for a temporary or permanent
restraining order against you?
NO
YES If yes, please explain:

_____________________________________________________________________________________
Is there any pending litigation against you?

NO

YES ___________________________________________________

Have you ever been diagnosed with alcoholism or drug addiction?

indicate how long youve been in recovery.

NO

YES If yes, please describe in detail and

_____________________________________________________________________________________
ELIGIBILITY REQUIREMENTS
1.
You must be a United States Citizen or legal resident residing in the United States.
2.

You must be at least 18 years of age.

3.
You must not be a candidate for public office and must agree not to become one until after the initial broadcast of the
programs in which you appear, if selected as a participant.
4.
Neither you nor any member of your immediate family or anyone living in your household may be currently
employed by or have been employed within the last two (2) years by, or be a close acquaintance of anyone employed by or
employed within the last two (2) years by, any of the following:
(a)
National Broadcasting Company, Inc. (NBC), its licensees, assigns, parent (General Electric Co.), or
affiliated or subsidiary companies (e.g., NBC Studios, Inc.) or any affiliated television station, or any
television station or channel that broadcasts the Program.;
(b)
Pulse Creative, Inc., Lock and Key Productions, Endemol Entertainment USA, Inc. or any of their respective
licensees, assigns, parents, or affiliated or subsidiary companies or any other person or entity involved in the
development, production, distribution or other exploitation of Fear Factor or any variation thereof.;
(c)
Any sponsor of Fear Factor or its advertising agency; or
(d)
Any person or entity supplying prizes or other services to Fear Factor.
5.
If selected as a participant you must execute waivers and release agreements required by NBC or the production
company.
6.
You will need to be available for approximately one week to the production and be willing to travel to one or more
locations within the United States.
7.
If selected as a semi finalist, you must be willing to submit medical information to the production and submit to a
medical examination, psychological examination, and background check.

8) How do you feel about opening up yourself and your life as an "open book" on national television?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
9) Do you know anyone who has or is applying for the show Fear Factor? (if yes, please list their names).
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
10) Do you now or have you ever owned or appeared on any web sites? No/Yes (If yes, please explain
and list sites):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
11) What other reality TV shows have you applied for? List the shows and month/year:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
12) Are you currently being considered for any other reality shows? If yes, please explain:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
13) When will you NOT be available between now and February 2006 to come to LA for one week?
Please specify conflict dates
_____________________________________________________________________________________
_____________________________________________________________________________________
Do you smoke?

Yes_______

No_______

Sometimes_______

Can you swim?

Yes_______

No_______

Not that well_______

> If no or not that well, EXPLAIN:_________________________________________

What is your height and weight?

Height:______________ Weight:______________

In the box on the side, please draw a self portrait:

In the lines below, write a short poem or rap

___________________________
___________________________
___________________________
___________________________

Please read, sign and date the following acknowledgement:

I hereby acknowledge that: (i) I have read and agree to be bound by the eligibility requirements; (ii) I have
answered the previous questions honestly and accurately; (iii) if any of the above information is found to be false or
incomplete this will be grounds for dismissal from the Fear Factor contestant selection process, and/or from the
Fear Factor contest, if selected; (iv) even if I meet the eligibility requirements, Producers have no obligation to
interview me, and/or select me as a contestant; (v) even if I am selected as a contestant, Producers have no
obligation to conduct the contest and NBC has no obligation to broadcast it, even if conducted; (vi) in the event the
show is cancelled, Producers and NBC have no obligation to award any prize money; (vii) all decisions by
Producers concerning selection of the contestants is final and not subject to challenge or appeal; and (viii)
Producers have no obligation to return any materials submitted by me as part of the application whether or not I am
selected as a cast member.
______________________________________________________________________________
Signature
Date
Please sign and date the following NAME AND LIKENESS RELEASE AND TRANSFER OF RIGHTS:
By submitting the application I hereby consent to the recording, use and reuse by the Producers of the Program
(defined below), NBC West, LLC, Endemol Project, Inc., Endemol Entertainment USA Inc., Lock and Key
Productions, Pulse Creative, and any of their respective licensees, assignees, parents, subsidiaries, or affiliated
entities and each of the respective employees, agents, officers and directors (collectively "Releasees") of my voice,
actions, likeness, name, appearance, biographical material, and any information contained in my application to be a
contestant in the Program or in any materials submitted by me in connection with my application (collectively
"Likeness") in any and all media now known or hereafter devised, worldwide in perpetuity, in or in connection with
the reality-based television series currently entitled "Fear Factor" (the "Program"). I agree the Releasees may use all
or any part of my Likeness, and may alter or modify it regardless of whether or not I am recognizable. I further
agree that Releasees exclusively own all right, title, and interest (including, without limitation, all copyrights) in
and to any video that I have provided in connection with my application and any other materials that I have
provided or may provide in connection with the Program (the "Materials") including, without limitation, the right to
edit, alter or modify the Materials and to use all or part of the Materials and my Likeness in any and all media now
known or hereafter devised worldwide, in perpetuity. I represent and warrant that the Materials (specifically
including, without limitation, any videotaped material) will be free from any pornographic or graphically violent
material, will contain no nudity, and will not contain any content that is contrary to law or which places any of the
participants appearing on or off camera at serious risk or harm. I further agree that Releasees may use my Likeness
and the Materials in connection with any promotion, publicity, marketing or advertisement for the Program. I grant
the rights hereunder whether or not I am selected to participate in the Program in any manner whatsoever. I release
Releasees from any and all liability arising out of its recording or use of my Likeness and/or the Materials. I agree
not to make any claim against Releasees as a result of the recording or use of my Likeness and/or the Materials
(including, without limitation, any claim that such use 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 have signed this release on the ____________ day of _______________________, 20_____.

Signature_________________________________________________________

Name (Please print or type)___________________________________________

Thank you for your time and effort in completing the form.
Dont forget to attach a photocopy of your Drivers License. Good Luck!