Buddy Program

Buddy Questionnaire

This information will be used by the Buddy Program Coordinators to match Buddies.

If you do NOT want your information shared with your Buddy Partner, please check here

Please complete only questions you feel comfortable answering.

Full Name:

Phone: Email: Preferred Contact Method: Phone Email

Address:

Is it important for you that your Buddy live nearby? Yes No

Please Check One:

I am a NEW MEMBER and would like a Buddy assigned to me.
I am a FREQUENT/INTERESTED Visitor and would like a Buddy assigned to me.
I am an ESTABLISHED MEMBER and would like to be a Buddy.

Do you have minor children living with you either full or part time?
No
Yes

If yes, please list ages:

Is it important for you that your Buddy have children? Yes No Doesn't matter

Your gender? Female Male

Do you prefer your buddy to be: Female Male Doesn't matter

Please provide your age:

Do you prefer you Buddy to be close to you in age? Yes Doesn't Matter

Please Indicate Your Interests: (Check all that apply)

Art and Photography
Play Sports
Hiking and Outdoor Activities
Cooking
Movies and Theater
Music
Travel
Dining
Museums
Watch Sports
Gardening
Political Action
Pets and Animals
Community Service
Fitness
Books
Other: Please specify other: