PLEASE AFFIX PHOTO HERE TOTAL WIPEOUT

which you feel best reflects your

personality.
Please put your name on the
back of the photo.
CONTRIBUTOR APPLICATION FORM
1. Please fill out the application form legibly, using dark-coloured ink or
electronically using a clear black font typeface. If you run out of space
answering any question, please use the back of the form and reference the
question(s) accordingly.

(Applications without photographs
will NOT be considered and
unfortunately photographs can’t
be returned to you)
2. You must fill out the entire application form. Do not leave any question
unanswered. If any question is not applicable to you, write N/A in the space
provided.
Failure to answer any question may be grounds for not considering your
application.

PERSONAL INFORMATION
PRINT Full name
(as on passport)
Preferred
name/nickname
Age
Sex
Full address

Postcode
Home telephone no.
Work telephone no.
Mobile phone no.
Preferred time to call
Email address
Website, eg MySpace
URL/Facebook page
Height
Weight
Next of kin – name
and relationship to
you

Next of kin – contact

numbers

Do you have a valid

passport?
Passport country of
origin and expiry
date
Where did you hear
about Total
Wipeout?

TOTAL WIPEOUT Application Form 2011 1

EDUCATION AND WORK INFORMATION
Please list all of your
qualifications

Present occupation
Job title and company

Previous
occupations

How much notice is

required for you to
get time off work?

TELEVISION APPEARANCES
Have you applied to, (Please provide dates and prize, if any, where possible)
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

Do you have any

children? (please tell
us their ages)

How would you

describe yourself?
(up to 50 words)

Five words your

friends/family would
use to describe you?

List all your hobbies

and interests and
clubs or societies
you belong to

TOTAL WIPEOUT Application Form 2011 2

MISCELLANEOUS
Why would you like
to appear on Total
Wipeout?

Is anyone else you

know applying for
the show? If so,
please give their
names

How competitive are

you in everyday life?
Please give
examples

What is the most

daring and/or
dangerous thing you
have ever done?
Describe the
circumstances

What are you afraid ACTION 1, 2 or 3 COMMENTS

of or do you dislike?
Falling
Choose a number
from 1 to 3 and add Water
comments where
necessary. Heights

1 = No fear Fire
2 = Dislike Flying
3 = Can’t stand Speed
Falling
into water
How would you Please circle or underline the appropriate number:
describe your (1 = Not fit, 2 = Slightly fit, 3 = Average, 4 = Fairly fit, 5 = Very fit)
physical fitness?
1 2 3 4 5
Please provide explanation/detail:

TOTAL WIPEOUT Application Form 2011 3

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

What sports
organisations have
you been a member
of?(school, club,
professional, etc)
Please list all that
apply and the levels
played

Would you be able

to provide a letter
from your doctor
confirming your
health and fitness is
of a standard to take
part in this
gameshow?

When was the last

time you jumped
into water?

Have you had any

traumatic
experiences?
If yes, please explain

Have you had any

previous injuries or
illnesses?
Please be specific

Do you have any

phobias?

TOTAL WIPEOUT Application Form 2011 4

Have you seen Total
Wipeout on BBC1?

Have you applied for

Total Wipeout
before? If so, what
stage did you get
to?

How much ACTIVITY 1, 2 or 3 COMMENTS

skill/confidence do
you have at the Balance
following activities? Bungee jumping
(Please be honest)
Hang-gliding
Choose a number
from 1 to 3 and add High diving
comments where Rock climbing
necessary. Rope climbing
1 = No experience Skydiving
2 = Some experience Skiing/
3 = Very experienced snowboarding
White-water rafting
Zip line
Scuba diving
If you won our
exciting cash prize,
what would you
spend it on?

AND FINALLY
If there is anything else exciting or important you would like to tell us, that you think we need to
know – this is your chance! Please note below.

TOTAL WIPEOUT Application Form 2011 5

DIVERSITY MONITORING
We would be grateful if you would complete the following to help us with our monitoring process.
The information provided will allow the broadcaster to monitor on-screen representation of ethnic
diversity and disabled people across its programmes.

What is your ethnic origin? Please indicate below:

I am white

 British

 Irish

 Any other white background (please describe):

I am mixed

 White and Black Caribbean

 White and Asian

 White and Black African

 Any other mixed background (please describe):

I am Asian or Asian British

 Indian

 Pakistani

 Bangladeshi

 Any other Asian background (please describe):

I am Black or Black British

 Caribbean

 African

 Any other Black background (please describe):

I am Chinese or other ethnic

 Chinese

 Any other (please describe):

TOTAL WIPEOUT Application Form 2011 6

Do you have any medical conditions, allergies, disabilities or requirements we should be aware
of? (Please give details) (To help you answer this question, disability is defined as a “physical or mental
impairment which has a substantial and long-term adverse affect on a person’s ability to carry out normal
day to day activities” A long-term effect is one which has lasted or is likely to last at least 12 months or for
the rest of your life)

Note: If you are successful in your application and come for an audition and are included in the final
show then we would need to have this information for safety purposes. If you do have a disability is there
anything we can do to make our audition and selection process more accessible to you? (e.g. you may
require wheelchair access if called for an audition.)

ELIGIBILITY REQUIREMENTS

• You must be 18 years of age or over.

• You must be able to swim.
• You must be fit, in good health and able to provide a doctors letter to confirm this.
• You must have a valid passport with at least 9 months validity from the date of any audition you
might be asked to attend. This passport or a copy of it must be provided as identification at the
audition.
• If selected, you must get confirmation from your GP stating you are fit to participate and have
vaccinations for Argentina. We will supply you with the letter that your G.P will need to sign. We will
also ask you if you have any criminal charges or convictions.
• If selected, you must be available to travel to Buenos Aires, Argentina, for the recording of the show
for up to eight days.
• You must not currently, nor in the past one 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, outgoing and up for a challenge!

We have a very busy schedule whilst recording in Argentina. Please do not apply if your main
motivation is a free trip to Buenos Aires as unfortunately you will not get to see much of the
place!

Unfortunately we can’t reimburse you for any expenses or costs incurred at any point during the
application, audition or casting process unless specifically agreed by us. Endemol’s decision is final and
we reserve the right to refuse any submitted application. If you are selected to participate in the
auditions, we will need you to complete a medical/insurance questionnaire at the audition which will
include information about any allergies or current or recurring injuries or illnesses to make sure you are fit
and healthy enough to take part in the show (if chosen)

TOTAL WIPEOUT Application Form 2011 7

RETURNING YOUR APPLICATION
Please complete this form, including the declaration and signature on the following pages and post it
back to us with a recent photograph. Please be aware that failure to include a photograph may mean we
are unable to process your application.
Please return the form by post to:
Total Wipeout
Endemol UK
Shepherds Building Central
Charecroft Way
Shepherds Bush
London
W14 0EE

DATA PROTECTION
IMPORTANT INFORMATION ABOUT THE USE OF YOUR DATA
1 Personal information which you supply to Endemol during the application, auditions and casting
process (including but not limited to information about your health ) will be used in a number of
ways, for example:
• in selecting potential contributors for the Programme
• to assess whether you are a suitable contributor in relation to the Programme
• to develop, produce and publicize the Programmes and
• (if you are selected to participate in the Programme) to broadcast and distribute the Programme
and exploit all allied and ancillary rights including but not limited to video, DVD, online, books and
magazines.

2 We will not publish your address or contact details.

3 Your personal information will be shared with members of the Programme production team and
relevant staff at the broadcaster of the Programme and in terms of health and criminal records
information, may be shared with the broadcaster and our and the broadcaster’s insurers.

4 Endemol will ensure that any information provided for the purpose of producing the Programme will
be used in accordance with the Data Protection Act 1998.

5 All information will be kept secure and treated as confidential and will only be disclosed with your
permission (including any permissions you give here or in the rest of the application process). In
submitting this application form you are consenting to us using your personal information as set out
in this section.

6 You have the right of access to the information held and used by us. If at any point you want to
update your contact details please email us at dataprotection@endemoluk.com and we will amend
our records.

7 Unless you specifically agree to be contacted by us your personal information will not be used for
any other direct commercial purposes including direct marketing.

Endemol would like to retain this application form for future related use when, for example, producing
similar programmes. Please note that if you agree to this, Endemol or its parent company, subsidiaries
and affiliates may contact you separately and you agree to Endemol passing to its parent company,
subsidiaries and affiliates information for this purpose. Your refusal to grant us such permission will in no
way influence our decision as to whether or not we use your application form, your information or you in
the Programme.

Please mark the box if you are happy for this to happen:

TOTAL WIPEOUT Application Form 2011 8

Please read the following:
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 and I agree to keep Endemol informed of any change to these
circumstances or the information and/or data set out in this application form.

ii If any of the information I have given in the application form or otherwise given to Endemol is found
to be false, Endemol will be entitled:

(a) to exclude me from the participant selection process at any stage; or

(b) to exclude me from appearing in the programme, if selected and if I have
taken part in the programme I may be required to forfeit any prize/benefit I
may have received.

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.

Please write YES in the box below to indicate that you have read and understood
the above:

.............................................................................................. Date...........................................

Please sign and date below to indicate your acceptance of the terms of the application:

Signed................................................................................... Date...........................................

Name (please print)..........................................................................................

Please note that, due to the anticipated high volume of applications, unsuccessful applicants will not be
contacted. We cannot guarantee to audition everyone who 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!

TOTAL WIPEOUT Application Form 2011 9