First Name:____________________ Last Name:_________________
Phone:_____________
Age:________
Parish Name:_____________ Parish Priest:_______________ Phone:
____________
Diocese:________________ Bishop:__________________ Jurisdiction:____________________
Height:____________ feet_________ in
Body Type (Petite, Slender, Athletic, No Comment, etc:)__________
Hair Color:____________
Eye Color:______________
Occupation:_______________
Smoker: Yes_____ No_____ No Preference_____
Drinker: Yes_____ No_____ No Preference_____
Single_____ Divorced_____ Widowed_____ No Preference_____
Have children? Yes_____ No_____
Desire children? Yes_____ No_____ No Preference_____
Please number from 1 to 10 your favorite activities with 1 being your
least favorite and 10 being your favorite.
Check other interests and leave blank any activities you are not
interested in:
Hiking_____ |
Movies_____ |
Museums_____ |
Painting/drawing_____ |
Running_____ |
Dancing_____ |
Reading_____ |
Playing team sports_____ |
Concerts_____ |
Biking_____ |
Travel_____ |
Watching TV_____ |
Camping_____ |
Music_____ |
Walking_____ |
Social Gatherings_____ |
Singing_____ |
Pet Lover_____ |
Evening at home_____ |
Play instrument_____ |
List any others not listed above: _____________________________________________
_______________________________________________________________________________
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