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? Incidence Type (check all that apply) Violence they were physically abusive they were aggressive/rough they physically assaulted me they restrained me they threatened me they sexually assaulted me they raped me they had a weapon other form of violence (please specify below) Theft they robbed me they refused to pay me they gave less money than what was owed to me other form of theft (please specify below): Time Wasting they booked and didn't show up they argued about money they sent a lot of texts they sent a lot of emails they cancelled last minute other form of type wasting (please specify below): Bad Behaviour they were creepy they gave me a bad feeling they were verbally abusive they under the influence of drugs or alcohol they had bad hygiene they had sores on their genitals they asked for unreasonable services they pushed my boundaries they refused to wear a condom they took off the condom without my permission they forced me to do something I didn't agree to they drugged me they harassed me they stalked me they were not alone they pretended to be a police officer other form of bad behaviour (please specify below): 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: 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? Have you reported this bad date anywhere else? Thank you for taking the time to fill out this Bad Date Report. Submit Confidential Report Δ Share this:TwitterFacebookLike this:Like Loading...
SWAN Waterloo