Dating Form
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Are you currently working or in school?
School
Working
Both
None
N/A
Other
Do you drink or smoke please be honest?
Both
Just Smoke
Just Drink
Other
Are you willing to go on dates?
Yes
No
Would you be a supportive partner?
Yes
No
Would you wanna come over a lot and cuddle?
Yes please
I’m busy mostly
I’ll try my best
Do you like shopping?
Yes
No
Depends
Are you shy?
Yes
No
Do you like affection?
Yes
No
Have you cheated before?
Yes
No
Marital status
Single
Divorced
Widowed
Other
E-mail
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Where you live
Please Select
Greater Accra Region
Ashanti Region
Eastern Region
Central Region
Western Region
Brong Ahafo Region
Northen Region
Upper East Region
Upper West Region
Volta Region
Height
Weight
Eye Color
Natural Hair Color
Measurements
Do you have a child?
Please Select
Yes
No
Where did you see this add?
Please Select
Email
Google
Facebook
Linkedin
Whatsapp
Twitter
Other
Give a brief description of yourself
Why you think we’d be a good couple?
Recent photo
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