CC Membership

Name *

Age *

Phone Number *

Email *

Gender *

Gender preference in partner *

Birthday *

Location *

Residing area within location

Ethinicity *

Height *

Home Language *

Religious views *

Hometown- where you grew up *

Education Level *

Company name & Job title *

I live *

3 Words that your friends would use to describe you *

Favourite hobbies and activities (name at least 3) *

Introvert or Extrovert? *

Introvert

Extrovert

A bit of both

Have you ever been married before? *

Do you have any children? If so, how many (and ages) *

Open to having children? *

Open to partner having children? *

Do you drink? *

Yes

No

Occasionally

Do you smoke? *

Do you experiment with drugs? *

Yes

No

Occasionally

Any tattoos or piercings? *

Qualities looked for in a partner (name at least 3) *

Ideal age bracket for your partner *

Preferred cultural/religious/ethnic backgrounds in a partner: *

Favourite physical features in a partner (name 3) *

Pet peeves/deal breakers (ie Smoking, religious etc): *

Tell us a little bit about your dating history *

Please upload a preferred picture plus a FULL LENGTH photo of yourself, not older than 3 months *

No Choosen File

(Max 1024 MB)

Please upload a copy of your ID or Drivers license *

No Choosen File

(Max 1024 MB)

For screening purposes, please leave your Instagram or LinkedIn handle. *

Do you accept our terms and conditions? (Can be viewed on our website www.curatedconnections.co.za) *

Yes

No

How did you hear about us? *

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CC Membership