FRIENDSHIP AND DATING APPLICATION FORM Telephone: 0808 168 4662 c/o The Kings Centre West Street Fareham POl 6 OEF Number County Home: inc STD Code Work: inc STD Code 1 1 , NAME First Street EMAIL ADDRESS DATE OF BIRTH Day Month n DO YOU SMOKE? Middle Town Postscode TELEPHONE NUMBERS Year HEIGHT? Feet @ eg single, divorced separated, widowed In ches Last Mobile inc STD Code Other ie next of Kin, Carer inc STD Code MARITAL STATUS If yes, how many per day? DO YOU DRINK? If yes, how much per week? PLEASE DESCRIBE YOUR ETHNIC ORIGIN eg British, black, white, African, Asian, European, American
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FRIENDSHIP AND DATING APPLICATION FORM Telephone: 0808 168 4662 c/o The Kings Centre West Street Fareham POl 6 OEF
Number
County
Home: inc STD Code
Work: inc STD Code
1 1 ,
NAME
First
Street
EMAIL ADDRESS
DATE OF BIRTH
Day Month
n DO YOU SMOKE ?
Middle
Town
Posts code
TELEPHONE
NUMBERS
Year
HEIGHT?
Feet
@
eg single, divorced separated, widowed
In ches
Last
Mobile inc STD Code
Other ie next of Kin, Carer inc STD Code
MARITAL STATUS
If yes, how many per day?
DO YOU DRINK ? If yes, how much per week?
PLEASE DESCRIBE YOUR ETHNIC ORIGIN eg British, black, white, African, Asian, European, American
DATING AGENCY APPLICATION FORM CONTINUED ...
DO YOU HAVE MOBILITY NEEDS?
eg Wheelchair , guide dog user
DO YOU HAVE COMMUNICATION NEEDS?
eg Vision, hearing aids
WHAT ARE YOUR HOBBIES AND INTERESTS?
eg sport, travel, collecting, music
PLEASE STATE YOUR PARTICULAR LIKES AND DISLIKES
Likes: Dislikes:
WHAT ARE YOU LOOKING FOR FROM YOUR DATE?
eg friendship, dating
PLEASE DESCRIBE YOUR IDEAL DATE
eg who, where, when
PLEASE DESCRIBE YOURSELF
eg funny, chatty, shy
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