FLIRT Application Form

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Thank you for applying to be a client with FLIRT! If you do not hear back from me within 2 business days, please email me at: tawniblake@gmail.com

First Name *

Last Name *

Email address *

How did you hear about Flirt *

Age *

Date of Birth: *

YYYY

Phone: *

Height: *

Hair color: *

Eye Color: *

What age range will you date? *

Ethnicity/Race *

Are you open to dating other races? *

Yes

Maybe

Is your goal a long term committed relationship? *

Yes

Maybe

How long have you been single? *

Are you divorced? *

Yes

If yes, how long have you been divorced?

If yes, how long were you married?

From when to when?

Do you have kids? *

Yes

What age(s) are your kids? *

Do you want kids (or more kids)? *

Yes

Maybe

Are you okay if your match has kids? *

Yes

Maybe

Any age range for your matches kids that you prefer? *

How long was your longest relationship? *

From when to when? *

When did your last relationship officially end? *

YYYY

How are you meeting people now? *

Have you ever met with a matchmaker? *

Yes

What part of town do you live? *

What part of town do you work? *

Do you own or rent? *

Own

Rent

Do you have roommates? *

Yes

What is your occupation? *

Your education level: *

Where did you grow up/go to high school? *

Where did you go to college? *

Degrees? *

Is education important to you in your match? *

Yes

Other:

Average yearly income: *

Is your match's income important to you? *

Yes

Maybe

Your religion? And how important is it to you and for your partner to share the same with you? *

Your politics? And how important to you and for your partner to share the same with you? *

What do you do for fun? *

Are you fit/in good shape? What activities do you do? *

Diet restrictions? *

Vegetarian

Vegan

Kosher

Halal

Gluten-free

None

Other:

Do have dogs or cats? *

Cat(s)

Dog(s)

Neither

Other:

Any pet allergies? *

Yes

Other:

Drinking habits with alcohol -- per week? *

Do you have tattoos? Do you care if your match does? *

Do you have a physical type? Or a type you WON'T date? *

What's important to you in a match? *

Describe yourself and your personality: *

Do you do any volunteer work? *

Yes

Other:

Favorite charity? *

Do you think it is currently difficult for you to meet a great match? *

Yes

Other:

If so why do you think that is?

Will you be open to going on dates for fun? *

Yes

Maybe

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