Bad Date Report Form
A place to report your bad dates in order to alert your community
When did the incident happen? (Date and time of day)
Where did the incident happen? (Where picked up, where taken, where dropped off)
Description of date: (height, weight, age, sex, skin color, hair color, eye color/glasses, facial hair, scars, tattoos, body type, hat, clothing worn, language/ voice)
Description of car: (type, color, year, any unique characteristics)
What happened? (Include details – what date asked for, if date paid and how paid, what happened, if weapon was used, amount and type of physical violence, quirky behavior.)
Would you like follow up from an advocate? If so, please leave safe contact information.
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