— date me — Name * First Name Last Name Email * Personal Phone Number * I will not contact you on this number if you provide a secondary number. (###) ### #### Secondary Phone Number (###) ### #### First Choice of Date * MM DD YYYY Alternative Date MM DD YYYY Time of Date * Hour Minute Second AM PM Date Duration * Date Location * Where did you find me? * Tell me a little about yourself and what drew you to me. I understand that Scarlett will reply to this form via email and I should check my "spam" folder before I follow up with her regarding my form. * Yes No (you will not receive a response) I understand that a deposit is required and I'm ready to send a deposit upon booking. * Yes No (you will not receive a response) I understand that Scarlett will conduct a screening after my deposit has been received. I understand that I'll be asked to provide screening information & I'm prepared to do so. * Yes No (you will not receive a response) Thank you! Your form has been submitted.