The Dating Concierge, Dating Database Entry
Hello & Welcome! This is your chance to get matched by Layla Book, The Dating Concierge. Its free to be part of the database. Complete your info and you will hear back if she has a client compatible for you
Sign in to Google to save your progress. Learn more
Full Name *
Last, First
You are *
Age *
What City are located? *
Relationship status *
Height *
feet, inches
Education level *
Profession *
What do you do, what is your career field?
Religious Observance Level *
Description of yourself *
Describe your personality, traits, values, hobbies, aspirations, what you do for fun. Be as detailed as possible. Please write full sentences.  
What are you looking for in your other half? *
In a few sentences describe the Characteristics/Traits/Values/Personality you are looking for in your match
Up to what age will you consider dating someone? *
Are you willing to relocate? *
Political Orientation *
Facebook Profile *
place a link to your FB profile page (this is only for Layla's use) If you don't have facebook write (I don't have)
Email Address *
used for matchmaking and other communications
Cell Phone *
for Layla's use only (unless permission is given to release to potential match)
Would you like to schedule a 20 min phone consult to learn more about becoming a VIP client? *
Terms of Use:This is a legal agreement ("Agreement") between you and Layla Book. By registering, you become a member of the Service (a "Member"), and you agree to be bound by the terms and conditions of this Agreement (the "Terms") for as long as you continue to be a Member.The following Terms are subject to change by Layla Book at any time, effective upon notice to you (which notice shall be deemed to have been received upon the posting of an updated Agreement on the Service). Minors may not become members. You represent and warrant that you are at least 18 years old by becoming a Member. Your membership to the Service is for your sole, personal use. You may not authorize others to use your membership, and you may not assign or otherwise transfer your account to any other person or entity. User Representations, Warranties, Covenants and Online Conduct. As a Member, you agree that: (1) You are solely responsible for the content or information you publish or display (hereinafter, "post") on the Service or transmit to other members of the Service. (2) You will not post on the Service, or transmit to other members or employees of Layla Book, any defamatory, inaccurate, abusive, obscene, profane, offensive sexually oriented, threatening, harassing, racially offensive, or illegal material, or any material that infringes or violates another party's rights (including, but not limited to, intellectual property rights, and rights of privacy and publicity). (3) You will provide Layla Book with accurate, current and complete information (including, without limitation, email contact information) about yourself as prompted by our registration forms ("Registration Data"), and to maintain and update such Registration Data to ensure that it is accurate, current and complete. In the event that Layla Book attempts to contact you by email (at the current email address you have provided in your Registration Data) and you do not respond to such email within 30 days, it shall be conclusively presumed that the email address you have provided is either inaccurate or no longer current. (4) You will use the Service in a manner consistent with any and all applicable laws and regulations. (5) You are solely responsible for your interactions with other users of the Service. Layla Book reserves the right, but has no obligation, to monitor disputes between you and other users of the Service. (6) By requesting to use, registering to use, and/or using this service, you represent and warrant that you have never been convicted of a felony and are not required to register as a sex offender with any government entity. Layla Book DOES NOT CURRENTLY CONDUCT CRIMINAL BACKGROUND SCREENINGS ON ITS MEMBERS. Layla Book will not carry the burden to conduct any of these screenings and it is up to the member to do their own due diligence.(7) Matches are not guaranteed.INDEMNITY BY MEMBER. You will defend, indemnify, and hold harmless Layla Book, its parents, subsidiaries, officers, directors, employees, agents and third parties, for any losses, costs, liabilities and expenses (including reasonable attorneys' fees) relating to or arising out of your use of the Service, including, without limitation, (i) any breach by you of the Terms, (ii) any allegation that any materials that you submit to Layla Book or transmit to the Service infringe or otherwise violate the copyright, trademark, trade secret or other intellectual property or other rights of any third party and/or (iii) any other activities in connection with your use of the Service. This indemnity shall be applicable without regard to the negligence of any party including, without limitation, any indemnified person.WARNING - PLEASE READ:. It is possible for others to obtain personal information about you due to your use of the Service, and that the recipient may use such information to harass or injure you. Layla Book is not responsible for the use of any personal information that you may choose to disclose on the Service. Please carefully select the type of information that you post on the Service or otherwise release to others.PROPRIETARY RIGHTS. Layla Book owns and retains other proprietary rights in the Service. The Service contains the copyrighted material, trademarks, and other proprietary information of Layla Book and its licensors. In addition, other users may post copyrighted information, which has copyright protection whether or not it is identified as copyrighted. Except for that information which is in the public domain or for which you have been given permission, you will not copy, modify, publish, transmit, distribute, perform, display, or sell any such proprietary information.INFORMATION SUPPLIED BY MEMBER. The personal information you provide Layla Book (including sensitive personal information) will be stored on computers. You consent to Layla Book's (and its affiliates') using this information to build a profile of interests, preferences and browsing patterns and to allow you to participate in the Service. You also agree to read, review, comply with, uphold and maintain Layla Book's privacy policy and the terms and conditions thereof. If you are located outside of the United States, please note that the information you provide is being sent to the United States. By becoming a member of the Service, you consent to your data being sent to the United States and to such other third parties and jurisdictions as may be involved in the provision and operation of the Service.DISCLAIMER OF WARRANTIES. Layla Book provides the Service on an "as is" basis and grants no warranties of any kind, express, implied, statutory, in any communication with Layla Book, or its representatives, or otherwise with respect to the Service. Layla Book specifically disclaims any implied warranties of merchantability, fitness for a particular purpose, or non-infringement. Layla Book, does not warrant that your use of the Service will be secure, uninterrupted, always available, or error-free, or will meet your requirements, or that any defects in the Service will be corrected.LIMITATION OF LIABILITY. In no event will Layla Book, be liable (i) to you for any incidental, consequential, or indirect damages (including, but not limited to, damages for loss of data, loss of programs, cost of procurement of substitute services or service interruptions) arising out of the use of or inability to use the Service, even if Layla Book, or its agents or representatives know or have been advised of the possibility of such damages or (ii) to any person other than you. Notwithstanding anything to the contrary contained herein, Layla Book's liability to you for any cause whatsoever, and regardless of the form of the action, will at all times be limited to the amount paid, if any, by you to Layla Book, for the Service during the continuous term of your active membership. WE DO NOT CONDUCT BACKGROUND CHECKS OR OTHERWISE SCREEN THE MEMBERS REGISTERING TO THE SERVICE IN ANY WAY. AS A RESULT, WE WILL NOT BE LIABLE FOR ANY DAMAGES, DIRECT, INDIRECT, INCIDENTAL AND/OR CONSEQUENTIAL, ARISING OUT OF THE USE OF THIS SERVICE INCLUDING, WITHOUT LIMITATION, DAMAGES ARISING OUT OF COMMUNICATING AND/OR MEETINGS WITH OTHER MEMBERS OF THE SERVICE, OR INDIVIDUALS INTRODUCED TO YOU VIA THE SERVICE. SUCH DAMAGES INCLUDE, WITHOUT LIMITATION, PHYSICAL DAMAGES, BODILY INJURY AND OR EMOTIONAL DISTRESS AND DISCOMFORT. IN ADDITION, LAYLA BOOK DISCLAIMS ALL LIABILITY, REGARDLESS OF THE FORM OF ACTION, FOR THE ACTS OR OMISSIONS OF OTHER MEMBERS OR USERS (INCLUDING UNAUTHORIZED USERS, OR "HACKERS") OF THE SERVICE.STATE BY STATE VARIATIONS. Certain jurisdictions limit the applicability of warranty disclaimers and limitations of liability so the above disclaimers of warranty and limitations of liability may not apply to you.TERMINATION. Either you or Layla Book may terminate your membership at any time, for any reason. In addition, Layla Book may, but is not obligated to, terminate your membership or subscription, without notice, if you breach or fail to comply with any of the Terms. Upon termination, you shall not be entitled to a refund of any fees previously paid, and Layla Book shall not be entitled to collect any fees not previously paid, by you.GENERAL PROVISIONS. This Agreement is governed by the laws of the State of California without regard to its conflicts of law provisions. You agree to personal jurisdiction by, and venue in, the state and federal courts in the State of California, City of Los Angeles. This Agreement shall not be governed by the United Nations Convention on Contracts for the International Sale of Goods, the application of which is hereby excluded. This Agreement, accepted upon registering for Layla Book’s matchmaking service, contains the entire agreement between you and Layla Book, regarding the use of the Service. This Agreement may only be amended upon notice by Layla Book, to you (which notice shall be deemed to have been received by you at the time of Layla Book's posting of an updated version of this Agreement on the Service), or by a writing signed by you and an authorized official of Layla Book. Unless otherwise explicitly stated, the Terms will survive termination of your membership to the Service. If any provision of this Agreement is held invalid, the remainder of this Agreement shall continue in full force and effect. *
State "I (Name) Agree to the Terms"
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy