Bad Date Reporting The information you provide will be kept anonymous. We will not be collecting any identifiable information about you, just the Bad Date. The purpose is to help others know who to avoid and situations to be aware of. There are 2 ways to submit a Bad Date Report: 1 Download and email your completed Bad Date Reporting Form to swanwaterlooregion1@gmail.com 2 Fill out the online reporting form below and click Submit when you are finished. Date of Incident Time of Incident (specify am/pm) Location of Meet Up Location of Incident How did this bad date contact you? in person they called or texted me they emailed me I don't remember other: specify below How did this bad date find you? in person / on the street print ad online I don't know other: specify below Can you provide the bad date's phone number and/or email address? Physical Description of Bad Date Age Name Gender Hair Colour Hair Type Facial Hair Height Weight Build Accent Ethnicity Glasses Clothing Tattoos (what and where) Scars (what and where) Piercings (what and where) Birthmarks (where and where) Any other physical details you wish to provide: Incidence Type (check all that apply) Violence physically abusive aggressive/ rough physically assaulted me put hands on object on my throat, making it hard to breath pulled hair punched slapped kicked other physical assault (please specify below) restrained me threatened me sexually assaulted or raped me had a weapon knife gun taser other weapon (please specify below) other form of violence (please specify below) Theft robbed me refused to pay before refused to pay after gave less money than what was owed to me other form of theft (please specify below): Time Wasting booked and didn't show up argued about money sent a lot of texts sent a lot of emails cancelled last minute other form of type wasting (please specify below): Bad Behaviour creepy gave me a bad feeling verbally abusive under the influence of drugs or alcohol bad hygiene sores on their genitals asked for unreasonable services pushed my boundaries refused to wear a condom took off the condom without my permission forced me to do something I didn't agree to drugged me harassed me stalked me was not alone pretended to be a police officer other form of bad behaviour (please specify below): Vehicle Description Condition outside clean outside dirty inside clean inside dirty Colour License Plate Smell Anything on the seat? Old / New Vehicle Brand (select) — Acura Audi BMW Buick Chevrolet Chrysler Dodge Fiat Ford GMC Honda Hyundai Infiniti Isuzu Jaguar Jeep KIA Land Rover Lexus Lincoln Mazda Mercedes Benz Mercury MINI Mitsubishi Nissan Oldsmobile Porsche Saab Scion smart Subaru Suzuki Toyota Volkswagen Volvo Vehicle Body (select) — Sedan Hatch-back Sports Car Convertible Station Wagon SUV Mini-Van Panel Van Pick Up Truck Cube Van Vehicle Model Other details about the car: Is there anything you'd like to add? Thank you for taking the time to fill out this Bad Date Report. Submit Confidential Report Δ Share this:TwitterFacebookLike this:Like Loading...
