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Area 1:
Please provide positive answers.

Name:


Age:


Phone:


Height:


Do you Drive:


State You Live In:


School:


Grade:


Single or Taken:


Would You Date Me:


Kiss On First Date:


Will You Send This Back To Me?:


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

I made a move on u:


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:


I got into a fight and you weren't there?


I asked u to have sex?


I told you I was depressed?



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..
[ ]Date me..
[ ]Kill me..
[ ]Love me..
[ ]Hate me..
[ ]Hold me..
[ ]Lie to me..
[ ]Hurt me..
[ ]Sing with me..
[ ]Dance with me..
[ ]Cuddle with me..
[ ]Let me make a move on you..
[ ]Make a move on me..
[ ]Watch a movie with me..
[ ]Get me a B-day gift..
[ ]Let me borrow your car..
[ ]Be there for me..
[ ]Buy me a drink..
[ ]Bring me around your friends..
[ ]Give me a massage..
[ ]Drink kool-aid with me..
[ ]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..
[ ]tell me you love me