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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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