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Bringing Home Baby

PARTICIPANT APPLICATION Thank you for your interest in "Bringing Home Baby." Please answer the following questions completely and submit the application with pictures of you and your family. Thanks again, and best wishes with your baby! Mother's full name: Address: City/State/Zip: Home phone: Cell phone: E-mail: Age: Due date: Marital status: Occupation: Is this your first child? If no, please list: Father / Partner's full name: Father / Partner's age: Father / Partner's phone: Father / partner's e-mail: Father / Partner's occupation: Is this your partner's first child? If no, please list: Doctor's name: Doctor's phone: Do you know the sex of your child? Have you picked out a name for your child? Where are you planning on having your baby? Address : Do you own or rent your home? Do you have any pets? If so, what kind and how many?

(HOSPITAL, HOME, OTHER)

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Where will the baby be sleeping? Describe your pregnancy? Easy? Difficult? Do you have any medical conditions or concerns? Please list any friends or family who will be assisting you the first few days following the birth and provide a brief description of each person.

What are three adjectives that describe your personality?

What are three adjectives that describe your partner?

What are your hobbies? Interests? Passions?

What are you looking forward to most about being a parent?

What are your biggest fears about becoming a parent?

Why do you think you would be a good candidate for the show? What makes you unique?

Have you or anyone who might be involved in this show ever been convicted of a felony, or a misdemeanor involving any violent act, use or possession of a weapon or act of dishonesty for which the record has not been sealed, expunged or dismissed following the completion of probation? If so, please explain. (The conviction of a crime will not automatically result in a denial of consideration.)

PLEASE SUBMIT VIA EMAIL or FAX TO: [email protected] 818-753-3101 (fax) 818-753-3100 (main)

Norsemen Television Productions LLC

4705 Laurel Canyon Blvd Suite 400 Valley Village, CA 91607

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