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.

1. Your Information:
Full Name:

Address:

City: Zip:

Phone: Email:

2. Preferred communication method: Phone Email

3. Is it important to you that your Buddy partner live nearby? Yes No

4. 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.

5. Do you have minor children living with you part- or full-time?
Yes - lists ages:
No

6. Do you prefer that your Buddy partner have minor children?
Select one... Yes No Doesn't Matter

7. Your gender: Male Female

8. Do you prefer your Buddy to be:
Select one... Male Female Doesn't Matter

9. Please provide your age:

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

11. Please indicate your interests (check all that apply):