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Area 1:

Please provide positive answers.

Name:
Age:
Height:
Do you Drive:
Single or Taken:
Kiss On First Date:

Area 2:
What would you do if I...

I made a move on you:


I kissed you:
I lived next door to you:
I started smoking:
I asked you on a date:
I was hospitalized:
I ran away from home:

Area 3:
What do you think about my...

Personality:
Eyes:
Hair:
Body:

Area 4:
Have you ever....

Lied to make me feel better?


Wanted to kiss me?
Wanted to kill me?
Broke my heart?
Kept something important from me?

Area 5:
"X" marks the spot
[ ]Kiss me..
[ ]Hug me..
[ ]Cuddle with me..
[ ]Make a move on me..
[ ]Watch a movie with me..
[ ]Be there for me..
[ ]Buy me a drink..
[ ]Bring me around your friends..
[ ]Give me a massage..
[ ]Take advantage of me..
[ ]Hangout with me...
[ ]Take care of me if I wasn't feeling good..
[ ]Hold hands with me..
[ ]Do something incredibly sweet for me..

[Anything else you'd like to say?]

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