Screening & Verification Form

We can’t always be together in person, but when there’s a will, there’s a way. I typically use Google Meets, Google Phone, SnapChat, Twitter Chats, or WhatsApp.

Your investment is only for my time and companionship. Nothing more is expected or implied.

What do you have in mind?*

Sexting (10 minutes) w/ 3-4 spicy photos ($25)Spicy 1-on-1 Phone Calls (10 minutes) ($50)Spicy 1-on-1 Video Chats (20 minutes ($130)Custom photos or videos (see my website for details)Social Date (please inquire)

Preferred days of the week & times? Any days or times that never work for you?

Please tell me more about what you would like to do with me during our time together.

Preferred way to chat (Google Meets, Mobile Phone, Snap Chat, Twitter Chats, WhatsApp)*

Username on that platform

Mobile Phone Number (Please, no burner phones)

Area CodePhone Number

Email

example@example.com

For in-person dates only

(not required for virtual dates)

Screening is important to me and is required for NEW friends before we meet to promote my safety and to get to know you better. I also have to screen out those people who are underage.

Before you begin to complete this form, please make sure you have a clear photo of your driver's license or government ID, as well as a selfie headshot photo of you holding that ID close to your face so both are clearly visible and readable together.

Your verification is not complete until this form has been completely filled out and ID and headshot photos uploaded. Once I have confirmed the information you have submitted, I will contact you regarding our encounter, including your investment.

Thank you for your understanding about this important personal safety issue.

IMPORTANT: Your verification is not complete and I will not confirm our meeting date and time until you have completed this form and I have received both photos. Do not submit any consideration until I have contacted you about the specifics of setting up our time together.

If you'd like more information about this, please see my website:

www.meetkatarinarose.com/screening

Name

Legal First NameLegal Last Name

Birth Date

MonthDayYear

Current Residential Address (even if it is the same as your Driver's License address)

Street Address

Street Address Line 2

CityState

Zip Code

Please upload a valid driver's license or government ID. You may obscure your license or ID number

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Please upload a selfie head shot photo of you holding your valid driver's license or government ID close to your face so your face, ID photo, and and address information are clearly visible and readable together. You may obscure your license or ID number.

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Is there anything else you would like me to know?

I will contact you once screening is successful to set up our time together. I'm looking forward to getting to know you more intimately!

Reservation & Screening Form