S4S - Information Sheet

(send via email to singles4singles@excite.com)

Name: _______________________________________   Date_________

Address: ________________________City: _______State: __­­­­­­___ Zip: __________

Home Phone: ____________________ Work Phone: _________________________

Cell Phone: _________________ Best Time To Be Reached: ___________________

E-Mail Address: ___________________

Age: _________ I prefer to date approximate age range: ____ to _______

Height:__________________  Marital Status (# of children)__________

Occupation: __________________________________

Educational Background: ____________________________________________________ of Affiliated Shul/Synagogue: ______________________________________________

Hashkafic Orientation (Please provide brief description): ___________________________________________________________________________

Interests/Activities That I Enjoy:

________________________________________________________________

Qualities That I Am Seeking In A Mate:

______________________________________________________________________

References (Please include telephone numbers): _____________________________________________________________________

Additional Comments and photo: