L i s t e n   T o   M u s i c
Click here for music embedded with frequencies
that will activate your Heart Chakra (energy center)
and open you up to receiving love while you enter the
answers and information on the Profile Form.
> Who do you live with?
> # of children you have?
> # you want?
SECTION II
> Country, State, City:
> Are you willing to relocate?
> Are you willing to have a long distance relationship?
> Age:
> Ethnicity:
> Dating restrictions based on their ethnicity:
> Ever been married?
> If you've never had a long term relationship, why not?
> WYD somebody who is raising children?
> Spiritual/religious orientation:
> Dating restrictions based on spiritual/religious orientation?
> Are you divorced or legally separated?
> Languages:
> Age range for mate:
> Astrological Sign and power numbers (if any):
> Restrictions based on distance/location:
- YENTA'S TERMS AND CONDITIONS -
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Rent-a Yenta is not responsible or liable for any issues or consequences due to conversing, dating, engaging, interactions or involvement with matches provided by the service.
Rent-a Yenta does not screen, do background checks or request medical records. Use of the service, sharing contact information, any arrangements, and all interaction and involvement is done at your own risk.
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Rent-a Yenta has the right to refuse my application, and to drop me from the service with no refunds if I do not provide honest information on the Profile Form, or if for any reason my conduct is deemed vulgar or inappropriate.
Referrals are made based solely on the information provided in the Profile Forms. Rent-a Yenta makes no promises or guarantees regarding referrals, nor is a match or long term relationship guaranteed in any way.
Rent-a Yenta will not share, reveal or distribute any of the information on my Profile Form without my consent. However, once that information has been shared Rent-a Yenta is no longer responsible for it’s privacy.
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The photo I provide is current and I still look the same as I do in that photo.
By submitting the Profile Form below I commit to entering honest and accurate information, and understand that if I don’t I diminish my chances of finding a true match. I do not engage in illicit behavior, immoral activities (including watching child pornography), am not violent or mentally abusive, and have no transmittable diseases. I agree to accept all of Yenta’s Terms And Conditions, including:
- PROFILE FORM -
* WYD = Would You Date (somebody who does/has)?
> Name (Last, First, Preferred if other):
> Link to a recent photo posted online (preferably on Facebook):
> Email:
> Facebook:
> Height:
> Describe your physical appearance:
> Physical attributes you find attractive in a mate:
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> WYD a non-caregiver who still lives at home?
SECTION I
* Information in Section I is NOT shared with referrals.
> Weight:
> Phone:
> Textbox: All textboxes scroll so enter as much info as needed.
If you need more time to complete the Profile Form and don't want to loose the information you've already entered, simply  point to "File" at the top of the browser, then click "Save Page As" and choose where you want to save it (preferably on your desktop). Please note that this works on Firefox, however, it may be different on other browsers. I recommend testing it before you begin.
If you're uncomforable with or choose not to answer some of the questions or requested information, just leave those parts blank. There will still be enough to establish compatability.
WYD somebody who is handicaped, has special needs or a severe deformaty?  (If so, briefly elaborate.)
WYD somebody with a non-contractual disease that requires ongoing treatments or medications? (If any, briefly elaborate.)
> Physical attributes you find unattractive in a mate:
> Referred By:
CLICK THE HEART TO SUBMIT YOUR FORM!
SECTION III
> Education:
> Are you supporting yourself?
> Job/Career:
> Dating requirements or restrictions based on income:
> Dating restrictions based on job/career:
SECTION IV
> Allergies:
> Would you date somebody with congenital herpes?
> Dietary preferences/restrictions:
> Dating restrictions based on diet:
> Are you emotionally stable? (If not, briefly elaborate.)
> Have you ever attempted suicide? (If so, briefly elaborate.)
> WYD somebody who's attempted suicide?
> Do you smoke cigarettes?
> How often do you drink beer or alcohol?
> How often do you drink wine?
> How often do you smoke marijuana?
> What illegal drugs do you use? (Briefly elaborate.)
> Have you ever had any addictions? (Briefly elaborate.)
> Have you ever been in an abusive relationship?
> Have you ever served time in jail/prison? (Briefly elaborate.)
> WYD somebody who's been in jail or prison?
SECTION V
> Are you bisexual?
> Are you a crossdresser?
> Are you looking for a monogomous or open relationship?
> Are you prone to extreme jealousy?
> Your mate should be open to threesomes with:
> How often do you watch adult pornography?
> Are you typically more kinky or conservative?
SECTION VI
> What sports so you like?
> Are you athletic?
> Do you like to travel?
> Favorite genre of music:
> What is your ideal climate?
> Are you a morning or night person?
> Political orientation:
> Do you own a gun?
SECTION VII
What are your top three...
> Skills:
> Talents:
> Hobbies:
> Interests:
> Goals/Ambitions:
> Dreams/Wishes:
SECTION VIII
How do you feel about...
> Recycling:
> Organics:
> Conventional Medicine:
> Vaccines:
> Welfare:
> Global Warming:
> Abortion:
SECTION IX
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> If you’re metaphysically gifted, please elaborate:
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> Do you believe Soul Mates/Twin Flames?
> Do you believe in Extraterrestrials?
> Have you ever been abducted?
> Do you believe you came from another world? (Briefly elaborate.)
> Define “Consciousness”:
SECTION X
> Describe your personality:
> What are your strengths?
> What are your weaknesses?
> Had/have a sex change?
> WYD?
> Where do you want to visit next?
> Favorite cuisine and food:
> Enjoy being outdoors?
> Roughing it?
> If you have, would you cheat again?
> WYD?
> WYD?
> WYD?
> What prescription drugs do you take regularly? (Briefly elaborate.)
> How much is too often for your mate to smoke marijuana?
> How much is too often for your mate to drink wine?
> How much is too often for your mate to drink beer/alchohol?
WYD?
> Health issues, including STDs? (If any, briefly elaborate.)
> What types of pets would you not want in your home?
> What qualities do look for, or not want, in a mate?
> What is some of your own “baggage”?
> What are your deal breakers in a mate?
> Describe a perfect first date:
What are your interests in the fields of metaphysics and/or new age phenomnon?
If you have established that you are a Lightworker, Walk-In, Indigo, other, elaborate briefly:
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YesNo
Man searching for Woman
Man searching for Man
Woman searching for Man
Woman searchng for Woman
Man searching for Woman or Man
Woman searching for Man or Woman
YesNo
YesNo
YesNo
YesNo
I like animals but don't want pets
I'm not an animal person
I have/want 1 pet
I have/want 2-3 pets
I'm ok with more than 3 uncaged pets
My home is full of pets
I have pets and farm animals
YesNo
YesNoMaybe
YesNo
YesNo
AnyOccasionallyMonthlyWeeklyOnce DailyHabitual
AnyOccasionallyMonthlyWeeklyOnce DailyHabitual
AnyOccasionallyMonthlyWeeklyOnce DailyHabitual
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
MonogomousOpen Relationship
YesNoNever Have
YesNo
Just MenJust WomenEitherNobody - just me!
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo