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Prey Application Form
Name: ______Age: ______
Nickname: ______
Current Address: ______
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Home #: ______Work #: ______
Cell #: ______Email: ______
Birthdate: ______Hometown: ______
Partner's Name: ______
Relationship to Partner: ______
Part I: About Me
1) Who is your current employer and occupation? ______
______
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2) Please list your last three jobs:
i)______
ii)______iii)______
3) What levels of education have you completed (please specify school and area of study):
______
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4) How long have you been in your current relationship?
(Circle One) Married / Divorced / Boyfriend/Girlfriend / Single / Engaged
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5) Do you belong to any affiliations or organizations?
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6) Do you have any military experience? ______
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7) Not including your current place of residence, in which other cities and/or countries have you lived and for what period of time? Why did you live in each such city or country?
______
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Part II: What’s Your Deal?
1) What would your friends say are your best qualities?
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2) What would your friends say are your worst qualities?
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3) Name your favorite hobbies.
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5) What magazines/newspapers do you read?
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6) What television shows do you watch?
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7) Name some of your favorite movies and musicians.
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8) What conversation topics are "off limits" for you at a dinner party? Why?
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9) What is the most daring and dangerous thing you have ever done? ______
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10) What accomplishment are you most proud of?
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11) Describe your most embarrassing or traumatizing moment:
______
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12) What are your phobias?
______
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Part III: Fit for the Challenge
1) Have you completed any wilderness survival training programs? If yes, describe.
______
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2) What sports organizations have you been a member of?
(i.e., High School; College; Minors; Professional; etc...)
______
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3) What sports or fitness activities do you currently participate in?
______
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4) Give an example of how far you can max your endurance levels (marathons, portaging, extreme hikes, etc)?
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5) Describe your experience with staying in the wilderness for long periods of time.
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6) How are you competitive in your every day life?
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7) What is your unique and personal motivation for wanting to compete on the show?
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8) If picked to be on Mantracker, what will you different than prey in the past? What's your secret weapon?
______
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Part IV: Teammates
1) How do you know your partner? How long have you known each other?
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2) Why do you want to take on Mantracker on national television with this person?
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3) Describe the relationship between you and your partner. (How do you get along together? Examples?)
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4) What worries you the most about your partner in taking on this challenge?
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Part V: Background Info
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:
______
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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) Have you ever been charged with any crimes? NO YES
If yes, please explain briefly:
______
6) 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:
______
7) Is there any pending litigation against you? NO YES ______
8) Have you ever been diagnosed with alcoholism or drug addiction? NO YES If yes, please describe in detail and indicate how long you’ve been in recovery.
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9) Are you currently being considered for any other reality shows? If yes, please explain:
______
10) Have you ever appeared on television before? (reality, game show, scripted etc.).
Show / Network / Approximate Air Date / Role / Prizes Won
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The information contained above is complete and accurate to the best of my knowledge.
Signature
Date