JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2024 Date Planning
In this questionnaire you'll find just a few questions to help us get started in planning your date! And remember, you can have a date in the middle of the week or the middle of the day. :)
If necessary, be sure you've arranged childcare.
Please submit 2-3 weeks before your desired date, if possible.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your Names
*
Your answer
What date do you have set aside on your calendar for your date? (Feel free to put multiple date options).
*
For example: Friday, November 4th
Your answer
What time-frame do you have set aside?
*
For example: 8 am to 12 pm or 6 pm to 11 pm
Your answer
Are you celebrating anything special this month?
*
Your answer
What the ideal amount you want to spend for your date this month?
*
Less than $50
$50 to $100
$100 to $150
$150 to $200
$200+
Other:
What kind of date do you want/need most right now?
*
Adventurous & Active
Cozy & Restful
Playful & Fun
Romantic
Surprise us!
Other:
Required
Is there a spot you've been really curious to check out that we could keep in mind for this month or future months?
Your answer
If applicable, is there any constructive feedback you have about your previous month's date or itinerary to help us nail it for this month?
Your answer
Is there anything else you would like us to know?
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of juniper.
Report Abuse
Forms
