Application Form: Southern Roots: Cooking from the Heart

Thank you for your interest in Southern Roots: Cooking from the Heart! Please fill out the following application completely. Incomplete applications may not be considered.

Name

First Name

Last Name

DOB

Date of birth must be at least 15yrs

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

emergency contact & phone number

Tell us about yourself (hobbies, interests, etc.):

What is your cooking experience?

Select one:

Do you have a favorite Southern dish? If yes, what is it and why?

Show Interest

Why do you want to participate in Southern Roots: Cooking from the Heart?

Do you have any family recipes or traditions you would like to share on the show? If yes, please describe:

What do you hope to learn or achieve during this competition?

Health and Dietary Information

Do you have any food allergies or dietary restrictions? If yes, please specify:

Do you have any medical conditions we should be aware of?

Media Release

Are you comfortable being filmed and having your image, voice, and likeness used for television and promotional purposes?

Parent/Guardian Consent (if under 18)

If you are under 18 years old, a parent or guardian must complete this section:

Name

First Name

Last Name

Phone

(###)

###

####

DOB

YYYY

Declaration

I confirm that all information provided is accurate to the best of my knowledge. I understand that participation in the show is subject to selection and the producers’ discretion.

Applicant Signature:

Date

YYYY

Application Form: Southern Roots: Cooking from the Heart

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