Dating Application Form

First Date with Martis the Love Coach

Singles Application
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Where are you Located?
City & State
Do you smoke or Drink?
Do you have children?
If yes, how many? (include in with your answer above
Are you open to dating someone with children?
What does a healthy relationship look like to you?
What age range are you interested in?
Do you have any physical preferences you’d like me to consider when selecting a potential match?
What are some of your interests/hobbies?
How do you identify?
Who are you interested in dating?
Are you currently working or in school?

Other
Height
What are you looking for right now?
Would you consider dating someone who lives in another city or state?
Please upload a recent photo of yourself

Cancelof
Give a brief description of yourself
What are your top 3 dating/relationship deal breakers?
Tell me a little about your dating journey. What has brought you to First Date with Martis?
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
First Date with Martis Participant Acknowledgment:
I understand that First Date with Martis is a virtual dating experience that may be recorded and/or broadcast live. I understand that submitting this application does not guarantee selection, participation, compatibility, or a romantic connection. If selected, I understand that additional participation, recording, media release, and program terms may be required before appearing on the show.

Please sign below if you agree.
Signature
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First Date with Martis the Love Coach