Interest Information

Please attach this to your registration for a Singles Session

Golden Singles

Name ________________________________

City and State ________________________________

Willing to travel in relationship?__________________________

Or relocate?________________________________________ Limits?______________

Age _______________________ Gender _____________

Occupation __________________________________

Three Qualities you like about you __________________________

Top Three Interests   ____________________________________

Spiritual Preference ____________________________________

Family History:  Past Marriage (s) _______________________________

Children _____________________________________________

Parents, Exes, Siblings, Best Friends _______________________________

Sexual Preferences; Straight      Gay /Lesbian     Bi       Trans

Dating Boundaries   range;  chastity ___   maybe _____  Casual _________

And How much do these boundaries mean to you?  1 for just a bit and 10 for very important __________


Your favorite thing about yourself ________________________________

Future Goals _______________________________________________

What you most want to learn next _________________________________

Anything you want to share; state of health, past challenges and present effects, deal breakers  etc.