Rehab

DISCLAIMER

All materials submitted to Doron Ofir Casting will be kept confidential and only used for the purposes of possible selection during the casting for REHAB with DR. DREW. All material will be destroyed after final casting.

Call our Casting Hotline with any questions or concerns: (323) 515-3260 or e-mail rehab@doronofircasting.com

Name:

Legal name as it appears on your state-issued I.D.: :

Current Street Address:

City:

State:

Zip Code:

Cell Phone:

Alternate Phone:

Email:

Facebook/Myspace ID/blog/etc:

Emergency Contact Name:

Emergency Contact Phone:

Current Place of Employment:

Full Job Title:

Have you ever appeared on television? (If YES please list project title, network and date of airing): :

How did you hear about this opportunity? :

Questionnaire

How would you describe you personality. :

How do others describe you? :

Please describe a typical day in your life. :

How do you party, What is fun to you? :

What are you addicted to? Please list all substances/behaviors associated with your addiction. :

Is there one thing that you are most addicted to? :

When did your use begin and how? :

When did you realize that you had an addiction? When did it stop being “just for fun”? :

How long have you been struggling with your addiction? :

What was your life like before your addiction began? :

What is life like now? :

How often are you using? :

What is the most extreme thing you have done to feed your addiction? :

Do your family and friends know that you have an addiction or do you hide it from them? :

Do you hide your addiction? If so, how?:

Please describe the ways your addiction has affected:

You? :

Your family? :

Your Relationship and/or Friendships? :

Your career and/or goals in life? :

How would you describe your addiction to those that may not understand it? :

Do you believe that addiction is a disease? :

Have you ever sought treatment for you addiction? Please list any kind of treatment you have tried for your addiction. :

Do you believe that treatment does work? :

What would you do if you were sober? :

Why do you want help? :

What is your greatest regret? :

Why should we choose you for this show? :

Finish this line: The party doesn’t end until:

I acknowledge that everything stated in this application is true. I understand that any falsely submitted answers can and will be grounds for removal from the casting process and from my subsequent participation in the pilot or final series. Whether or not I am selected to be an on-camera participant in the television series presently entitled Rehab with Dr. Drew (working title)(the “Project”), I acknowledge and understand that I may be taped and otherwise recorded during the interview and application process, and that Doron Ofir Casting may use such recordings, and my name, voice and likeness, in any manner and for any purposes (including the Project and in any related or derivative versions and/or uses of the Project) in all media now known or hereafter devised throughout the world in perpetuity for no compensation. I further acknowledge and accept that this application form and any other materials (including, but not limited to, any photographs, videotapes, etc.) that I have submitted or will submit to Doron Ofir Casting will become the property of Doron Ofir Casting and will not be returned. By signing below, I hereby grant Doron Ofir Casting the right to use my name, voice and likeness and any biographical information contained in this application, my home video, taped interview and any other materials submitted by me in any manner and for any purpose in all media now known or hereafter devised throughout the world in perpetuity without any compensation to me in regards to this casting. Such rights shall include, without limitation, the right to record, use, publicize, distribute and otherwise exploit my home video tape or taped interview, voice, actions, likeness, biographical information and appearance and any other material submitted by me in any manner and for any purpose (including, without limitation, in connection with Doron Ofir Casting).

I have read and agree to all terms

Upload a picture:

Are you over the age of 18?:

yes