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Dating Survey

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dating survey
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  • Added: September, 06th 2010
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  • Pages: 9
  • Tags: dating, survey, questionnaire
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  • Name: Jane Mary
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Content Preview
Dating Survey
Applicant’s Full Name_______________________________
Applicant’s Nicknames_______________________________
Age _____
Height_____
Weight______
Occupation _____________________________
If you could be any animal, which would you be and why?



What would you do if you saw an old lady lose her purse?




What is your favorite type of music and why?




Which of these do you believe in (Circle all that apply)?
a.
Zombies
d.
God
b.
Aliens
e.
Donald Trump’s Hair
c.
Bigfoot
f.
Mario
If you saw monsters in your closet what would you do?



Which of the following describes you (Circle all that apply)?
a.
Brave
d.
Smart
b.
Angry
e.
Bigfoot
c.
Happy
f.
Insane
Please state specific reason(s) for your last breakup.



Has a restraining order ever been filed against you (if yes, please explain)?






Have you ever been convicted of a felony (if yes, please explain)?




Do you currently have a driver’s license?




Have you ever been married?




Have you ever undergone sexual reassignment surgery?




Are you currently taking any medications?




Do you have piercings/tattoos? Please specify where and how many.




Do you floss your teeth? YES/NO

Do you wax/shave your chest? YES/NO
Why are manhole covers round?



Do you wax, shave, or pluck other regions of your body? YES/NO

Do you smoke cigarettes/cigars? YES/NO
How many drinks do you consume on average on a weeknight? _____________
How many drinks do you consume on average on a weekend? _____________
What would I find in your refrigerator right now?



What time do you wake up on weekends? _____________

Which side of the bed do you prefer to sleep on?


How often do you travel for work and to where?



How much time do you spend looking in the mirror per day? ____________________________________________________________

Does it take you longer than fifteen minutes to get ready?


How many “psycho” ex-girlfriends do you have (please explain)?




How many gas stations would you say there were in the United States? ______________________________________

Can you provide written documentation that you are free of STDs? YES/NO

Do you have any dysfunctions that cannot be treated by a doctor (Please Explain)?




If you were a salad, what kind of salad dressing would you have and why?



Please specify all fetishes.




Check applicable sleep conditions: ___ sleep apnea ___bed wetting ___ sleep-walking ___sleep-talking ___random thrashing ____cover hogging

Have you ever been suspected of cheating on a former girlfriend? Please explain.



Will you dance? Why or why not?



Do you own cats? Why or why not?




Do you like garlic? Why or why not?






Do you have children? Why or why not?



What makes you angry?




Do you like children? Why or why not?




Do you live alone or with a roommate?



Do you have a good relationship with your mother? Why or why not?




What is your preferred mode of communication? ___ text ___phone ___email ___IM ___Post-It note ____social networking site


Describe your perfect first date.



Have you ever kissed a friend or stranger on their hands or their head/neck region as a friendly gesture? YES/NO

Have you ever held hands with someone? YES/NO

Have you ever had a date? YES/NO

Have you ever had a date past 1 a.m.? YES/NO

How many close friends do you have? ______________

Have you ever dated someone on a regular basis? YES/NO

Have you ever written anonymous "love letters" to someone? YES/NO

Have you ever yelled/screamed obscenities? YES/NO

Have you ever made obscene phone calls? YES/NO

Have you ever stuffed your pants? YES/NO

Have you ever made an X- or R-rated snowman or snowwoman? Why or why not?



Have you ever willingly urinated on any part of your body? Why or why not?





Have you ever willingly defecated on yourself? Why or why not?




Have you ever plagiarized? Please explain.




What is the most important part of a sandwich?



Have you ever stolen? Please explain.




Have you ever written out a check that bounced? Please explain.




Have you ever used someone else's credit card without their knowledge and/or consent? Please explain.




Have you ever committed breaking and entering? Please explain.




Have you ever seen a snuff film? Please explain.




How do you know when a Smurf suffocates?




Have you ever told someone that you loved them when you did not? Why or why not?




What color is your toothbrush? ________________________

Have you ever urinated on someone else intentionally? YES/NO

Have you ever stored evacuated excrement anywhere else in your room, apartment, house, habitation, office, etc? YES/NO


In a small room you have a refrigerator, if you left the door of the 'fridge open would the temp in the room fall or would the temp in the 'fridge rise? Why?




Have you ever farted (audibly) in mixed company? Please explain.




Have you ever been arrested? Explain the circumstances.




Have you ever willingly committed incest? With which family member?




Can you describe an atom?




Have you ever committed adultery? Why or why not?



Have you ever bought lingerie/undergarments of the opposite sex? Did you wear it or give it to someone else?




Have you ever intentionally taken someone's underwear and didn't know who it belonged to? YES/NO

Have you ever thrown up from having drunk too much alcohol? How often?



What is a “light year?”




Have you ever passed out due to having drunk too much alcohol? How often?



Have you ever used a commercial aphrodisiac? (Spanish Fly, Magic Love Drops, powdered rhino horn, etc.) Why or why not?




Have you ever had an imaginary friend? YES/NO

Have you ever injected any drugs into your body for any other purpose other than medical? Which drug?




Have you ever gone to class or work while under the influence of drugs? (including alcohol)




How would you design a spice rack for a blind person?




Have you ever sold possessions in order to obtain drugs? Why or why not?




What shampoo do you use? __________________________________________________

Have you ever given a hickey? Please explain.





How do people normally react to you when you enter a large party?




How old is the oldest cell in your body? ________________________________

Have you ever practiced cocrophilia? YES/NO

Have you ever practiced infantilism? YES/NO

Have you ever practiced klismaphilia? YES/NO

Have you ever practiced necrophilia? YES/NO

Have you ever practiced mysophilia? YES/NO

Have you ever practiced urophilia? YES/NO

Have you ever listened to dirty jokes in mixed company? YES/NO

Have you ever told dirty jokes in mixed company? YES/NO

Describe your ringtone.




Have you ever received an enema for a purpose other than medical?




Have you ever used a whip, chain, cat-o-nine-tails, or something similar for pain?




What were you doing at midnight last night?




Have you ever worn a collar and/or leash?




Have you ever used an inflatable doll?




Have you ever been aroused by the sight of animals having being intimate?




Have you ever attempted to be intimate with a live animal, but failed?




Have you ever mutilated or killed any living animal or creature for your pleasures?




Have you ever successfully been intimate with an animal? (Alive or dead.)




Have you ever cross-dressed in the garments of the opposite sex?




What is the longest you’ve gone without taking a shower or bath? ____________________________________________

Have you ever had your head inserted into a urinal or toilet bowl willingly?




Have you ever played in or with feces? YES/NO


Have you ever been intimate in a place of religion?




Have you ever been intimate in a place of the dead?




Have you ever intentionally made "animal" noises during intimacy?




Have you ever placed a personal ad?




Have you ever drank human blood?




Have you ever tasted someone else's nasal mucosa?





I ATTEST THAT THESE ANSWERS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF PERJURY.
X ____________________________________________________________________________________________________



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