Celebrity Dating

Your Name (required)

What city do you live in? (required)

Select a State (required)
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Date of Birth (required)

Age (required)

Height (required)

Social Media Handles: One per line

Gender (required)
MaleFemale

Email (required)

Phone Number (required)

Profession

Tell us about yourself and your life. Include what your dating life is like. Have you ever dated a celebrity?: (required)

How did you hear about the show? (required)

You must upload at least one photo of yourself but can attach up to two additional photos. 5 MB max per photo.

Photo 1: (required)
Photo 2:
Photo 3:

Yes, I would like to be notified of future casting opportunities.

I have read and agreed to the terms of service.

TERMS OF SERVICE: Producer has no obligation to return any materials submitted by me as part of the participant selection process or in connection with my participation in the Program (the “Materials”) whether or not I am selected as a participant, and I hereby grant Producer the right to, and understand that Producer may, but is in no way obligated to, use any portion of the Materials in and in connection with the Program or any other program(s); and (x) Producer shall have the right to use my Likeness, the Recordings and the Materials in any manner, in whole or in part, in any and all media now known or hereafter devised in perpetuity throughout the universe.