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First & Last Name (of person filling out application) *
City and state where you live *
Telephone number *
How did you hear about this show? *
Please list the members of your family (include ages and occupations, if applicable). *
Do you all live under the same roof? *
If NO, please explain.
Tell us about each of your family members. *
Tell us about your family dynamic? How do you interact with each other on a day-to-day basis? *
Which members of your family are closest to each other?
Did your family used to be closer than it is today? If so, what used to be different? Do you have any favorite memories of that time? *
Was there a specific event or experience that happened that changed your family dynamic? Please describe. *
What are the problems or issues your family is currently facing? Is there anything specific that your family has experienced in the past or is currently experiencing that is impacting your closeness? *
What are the symptoms of these problems facing your family? *
Have you or your family tried other ways of fixing the problem? If so, what have you tried? *
Did it ever work? If it did, for how long did it work? If not, why didn't it work? What would you have done differently?
Do you think anyone in your family has a secret or is hiding something that is causing family issues?
Are there any outside influences affecting your family or adding to the problems? *
Tell us about how you would like your family to be, instead of how it is now. *
Despite the specific problems you and your family may be facing, what do you love most about them? Why is your family worth fighting for?
Why do you think your family needs this show? What makes your family different or special? *
Does your family know that you reached out to us? *
Does anyone in your family have Instagram? If so, please list their Instagram handles below.
Does anyone in your family have Facebook? If so, please list their Facebook page links below.
Does anyone else in your family have any other social media accounts? If so, please list below.
Has anyone in your family ever appeared on TV before? List all appearances and when they aired.
Please upload a picture of your family. If you have multiple pics you'd like to share, please upload them in the fields below. *
Upload additional photo here (OPTIONAL)