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					    AFFIX PHOTO HERE              CONTRIBUTOR APPLICATION FORM FOR TOTAL WIPEOUT GAMESHOW
    which you feel best
 reflects your personality        1. Please fill out the application legibly, using dark coloured ink, or
PLEASE PUT YOUR NAME              electronically. If you run out of space answering any question, please use the
       ON THE BACK                back of your questionnaire form and reference the question(s) accordingly.
   (Applications without          2. You must fill out the entire application. Do not leave any question
 photographs will not be          unanswered. If any question is not applicable to you, write N/A in the space
        considered)               provided. Failure to answer any question may be grounds for not considering
   No larger than 2 MB if         your application.
  attaching electronically
                                                                                         TH
                                CLOSING DEADLINE FOR APPLICATIONS IS FRIDAY 7                 NOVEMBER 2008


           PERSONAL INFORMATION

           How/Where did you     Please be specific
           hear about the
           show?

           Full Name
           (as on passport)

           Preferred Name /
           Nickname

           Age

           Sex

           British Passport                                Place of Birth
           Holder? (yes/no)

           Full Address




           Postcode

           Home telephone
           no.

           Work telephone no.

           Mobile phone no.

           Preferred time to
           call

           Web eg. Myspace                               Email Address
           URL or Facebook
           profile name

           Height                                        Weight

           Next of Kin –                                 Next of Kin – contact
           Name/Relationship                             numbers

           APPLICATION FORM TOTAL WIPEOUT GAMESHOW 01.09.08                                                   1
EDUCATION & WORK INFORMATION

Please list all of
your qualifications



Present occupation    Job Title and Company:



Previous
occupations:

Are there any dates                               How much notice is
you will not be                                   required?
available for
between the dates
            nd
October 22 and
             rd
December 3 2008

TELEVISION APPEARANCES

Have you applied      (PLEASE PROVIDE DATES AND PRIZE, IF ANY, WHERE POSSIBLE)
to / auditioned for
or appeared on
television before?


                        Failure to provide complete and accurate information on this part of your application
                              may result in Endemol reconsidering your contribution to the production.

Have you ever won
anything before, if
so what and how?

ABOUT YOU

Relationship status

Children (please
tell us names/ages)



How would you
describe yourself?
(up to 50 words)

And five words
your friends/family
would use to
describe you?
List all your
hobbies and
interests / any
clubs or societies
you belong to.


APPLICATION FORM TOTAL WIPEOUT GAMESHOW 01.09.08                                                                2
Reason / personal
motivation for
wanting to appear
on this show?
Is there anyone
else you know that
is applying for the
show? If so, please
give their names
here:
MISC
How competitive
are you in every
day life?
Please give
examples
What is the most
embarrassing thing
that has ever
happened to you?
What is your
greatest
achievement?
What is the most
daring and/or
dangerous thing
you have ever
done?
Describe the
circumstances:

What are you afraid     1=No Fear 2=Dislike 3 =Can’t Stand COMMENTS
of or dislike? Circle   Falling      1 2 3 __________________________________
a number 1-5.           Water        1 2 3 __________________________________
Add comments
where necessary.
                        Heights      1 2 3 __________________________________
                        Drowning 1 2 3 __________________________________
                        Fire         1 2 3 __________________________________
                        Flying       1 2 3 __________________________________
                        Falling into
                        water        1 2 3 __________________________________
                        1= Poor 3=Average 5=Very fit
How would you
describe your           Please circle or underline the numbers.
fitness?                    1 2 3 4 5
                        (Please provide explanation/details here)

Do you work out?
If so, what types of
activities and how
often? (please be
specific)

What sports
organisations have
you been a
APPLICATION FORM TOTAL WIPEOUT GAMESHOW 01.09.08                                3
member of (i.e.
school; clubs;
professional; etc.)?
Please list all that
apply and the
levels played.

How much               FOR EXAMPLE                                    COMMENTS
skill/confidence do    Bungee Jumping 1 2 3 Never done it but would do it
you have at...?
(be honest)
                                                               COMMENTS
1= no experience       Balance           1    2    3 ________________________________
2=some experience      Dancing           1    2    3 ________________________________
3=very experienced
                       Bungee Jumping 1       2    3 ________________________________
                       Martial Arts      1    2    3 ________________________________
                       Contact Sports    1    2    3 ________________________________
                       Gymnastics        1    2    3 ________________________________
                       Hang gliding      1    2    3 ________________________________
                       High Diving      1    2    3 ________________________________
                       Running          1    2    3 ________________________________
                       Rock Climbing    1    2    3 ________________________________
                       Rope Climbing 1       2    3 ________________________________
                       Skydiving        1    2    3 ________________________________
                       Any board sports
                       eg snowboarding 1     2 3 ________________________________
                       Boxing           1    2 3 ________________________________
                       White-water
                       Rafting          1    2 3 ________________________________
                       Zip Line         1    2 3 ________________________________
                       Press Ups        1    2 3 ________________________________
When was the last
time you jumped
into water?
Have you heard of
the show known
internationally as
“Wipeout”? If so,
what are your
thoughts on the
show?
Have you had any
traumatic
experiences?
If yes, please
explain:
Have you any
previous injuries or
illnesses?
Please be specific.
Do you have any
have any phobias?


APPLICATION FORM TOTAL WIPEOUT GAMESHOW 01.09.08                                        4
List other talents
(or party tricks or
unusual hobbies or
interests) in the
space below:


AND FINALLY

Is there anything else you would like to tell us?




Ethnic diversity      No one will be excluded from taking part in the programme on the grounds of
monitoring            race, religion, disability or sexual orientation. We would be grateful if you would
                      complete the following to help us with our monitoring process:
                      The information provided below will allow the broadcaster to monitor on-screen
                      representation of ethnic diversity and disabled people across its Programmes.
                      Asian / Asian British                             []
What is your
                      Black / Black British                             []
ethnic origin?
                      Mixed Ethnic Group                                []
                      Black Other                                       []
                      White/White British/Irish                         []
                      Other (Please specify)                            [ ] ____________________


Do you consider       Yes / No
yourself to have a
disability?           If yes, which of the following descriptions best describes your disability?
                      Visual
                      (NOT corrected by wearing glasses or contact lenses)                        []
                      Co-ordination, dexterity or mobility                                        []
                      Mental health                                                               []
                      Speech                                                                      []
                      Learning disabilities                                                       []
                      Hearing                                                                     []
                      Combination of above /
                      or other physical or mental conditions                                      []
Do you have a         Yes / No
criminal record?

Have you ever         Yes / No
had any criminal
charges made
against you (ie
that might have
been
discharged)?
If yes to either of
the above, please
give details
including dates.
APPLICATION FORM TOTAL WIPEOUT GAMESHOW 01.09.08                                                            5
AUDITIONS

        We regret that we are unable to reimburse travelling expenses to attend any auditions.
  PLEASE BE AWARE THAT AUDITIONS WILL TAKE PLACE THROUGHOUT OCTOBER AND
                              NOVEMBER 2008
                                                                        st,   nd       rd
PREFERRED AUDITION VENUE (Please put in order of preference, 1 2                   and 3 choice,

LONDON                                            BIRMINGHAM

MANCHESTER                                        NEWCASTLE

BELFAST                                           CARDIFF

                              GLASGOW

Please complete this form and send it back to us with a recent photograph
via email to: applications@endemoluk.com

or you can post it to:

WO – Mark Stanworth
Initial
Shepherds Building Central
Charecroft Way
Shepherds Bush
London W14 0EE


DATA PROTECTION

ALL APPLICANTS MUST BE OVER 18 YEARS OLD

              **IMPORTANT INFORMATION ABOUT THE USE OF YOUR DATA**
Endemol UK plc t/a Initial (the production company) (“Endemol”) will ensure that any information
provided for the purpose of developing or producing NEW GAMESHOW (the “Programme”) will be
used in accordance with the Data Protection Act 1998. All information will be kept secure and treated
as confidential. Any disclosures of information will only be made with your permission. You have the
right of access to the information held and used by Endemol. By submitting this application form, you
are consenting to the use of the personal information contained therein (including information about
your health) and any supporting material (“Personal Data”) for (a) the purpose of developing and
producing the Programme and any associated programme and the publicity, promotion, distribution
and use thereof, (b) to select potential contributors for NEW GAMESHOW (c) to assess whether you
are a suitable contributor for NEW GAMESHOW and/or (d) where required by operation of law. Your
Personal Data will not be used for any other direct commercial purposes including direct marketing.
We will not publish your address or contact details.

Endemol would like to keep this application form for future related use when, for example
producing similar programmes. If you do not consent to this it will not influence our decision in
the auditions and selection process. Please tick the box to indicate that you are happy for this
to happen       

If you do not consent to the future use of your information your application forms will be
securely destroyed once the selection process has been completed.


APPLICATION FORM TOTAL WIPEOUT GAMESHOW 01.09.08                                                    6
DECLARATION

i.       I have answered all of the questions on the application form fully, honestly and accurately
and I confirm I have not misled or attempted to mislead Endemol in any way as to my identity
experiences or health or in any other way I agree to keep Endemol informed of any change to
these circumstances or the information and/or data set out in this application form. If I am found
to have knowingly supplied inaccurate, misleading or false information I understand I may be
immediately disqualified from taking part in the programme;
ii.      If any of the information I have given in the application form is found to be false, Endemol
will be entitled to exclude me from the participant selection process;
iii.     I understand that even if I am selected as a participant, Endemol have no obligation to
produce the programme and if the programme is made there will be no obligation on the
producers or any broadcaster to broadcast it.
iv.      All decisions by Endemol concerning selection of the participants are final and I agree
not to challenge or appeal against those decisions.



 Signed …………………………………………………… Date ………………………………

 Name (please print) …………………………………………………………



We will be holding auditions for short-listed applicants throughout September and October. Please
note due to the anticipated high volume of applications, unsuccessful applicants will not be contacted.
Finally, we cannot guarantee to audition everyone that applies and due to the volume of response we
cannot acknowledge receipt of your application.

We would also like to state at this stage that receiving an application form or an audition date DOES
NOT automatically mean that you will be appearing on the programme and we reserve the right at any
time to stand down a contestant, even if you have been given a recording date. Please do not contact
us by phone unless you are instructed to do so.
Good luck!



ELIGIBILITY REQUIREMENTS


       Must be over 18 years of age
       Must be able to swim
       If selected, must be available for travel to Buenos Aires, Argentina for recording of the show
                                        nd
        for up to one week between 22 October – 3rd December 2008
       Must have at least nine months validity on your passport; with proof of this brought to the
        audition (either a photocopy or the original)
       If selected, you must get confirmation from your GP stating you are fit to participate,
        vaccinations for Argentina and be prepared for us to do a criminal background check
       Must not currently, nor in the past 1 year, be an employee, officer, director or agent of
        Endemol UK or BBC associated companies or affiliates. This also applies to any member of
        your immediate family
       And most importantly, you must be fun, out going and be up for a challenge!




APPLICATION FORM TOTAL WIPEOUT GAMESHOW 01.09.08                                                          7