First Name *
Last Name *
Email *
City *
State *
Phone Number? *
Date of Birth? (you must be over the age of 21 to fill out this application) *
*REQUIRED* Upload a CURRENT photo of yourself: CLEAR, unfiltered photo of your SMILING (with teeth) face: *
Please upload a photo with a complete body shot: *
Please list all websites, usernames, handles etc. that apply to you INCLUDING Personal and Professional Website, Facebook, Twitter, Instagram: *
Occupation *
Are you currently being considered for any other reality show, including any game or contestant shows? If so, please describe: *
Do you have a valid passport? If YES, please provide expiration date. *
We're searching for 2 generations to go to an island together– both participants MUST be single (divorced, never married, etc). Do you have a family member (either mom or dad, or son or daughter) that would want to participate with you to help navigate dating on a TV show? Who is this person and describe them (name, age, contact information). *
Please upload a CLEAR photo of the FAMILY MEMBER you'd like to join you: *
Are you single, married, or divorced? What is your ideal type or physical traits you like in a romantic partner? Do you have any kids? *
What's your ideal romantic type? *
What is your current dating life like? What do you believe needs to change in order for you to find "the one"? *
Have you ever dated someone significantly younger or older than you? Tell us about your experience with them! *
Have you ever acted, performed, or appeared on television or film? YES or NO? (Reality/game/competition/talk/web/documentary/etc). If YES please include SHOW NAME, NETWORK, TYPE (Reality, web, film), AIR DATE, AMOUNT WON/PAID: *
How did you hear about this casting? *
Eligibility Requirements and Release *
Eligibility Requirements and Release Signature *