Girlfriend Application For Keith
Contact Information
Name
Street Address
City ST ZIP Code
Home Phone
Work Phone
E-Mail Address
Availability
During which hours are you available to go on dates?
___ Weekday mornings
___ Weekend mornings
___ Weekday afternoons
___ Weekend afternoons
___ Weekday evenings
___ Weekend evenings
Interests
Tell us in which areas you are interested in as a date
___ Movies
___ Fancy Dinner
___ McDonald’s
___ A Walk on the Beach
___ Simply Hangout
___ Cuddle up and stay in
___ Hit the gym
___ Go shopping
Special Skills or Qualifications
Summarize special skills and qualifications you have acquired from dating,through other activities,
including hobbies or sports.