YENTA

Cleveland Yentas Matchmaking Information Form

Welcome to Cleveland Yentas - Jewish Matchmaking. Please answer the questions below, so we may best match you with your beshert (destiny). The answers are for Yenta eyes only. Your answers will not be shown to potential dates, so please be candid.

Name*

First Name

Last Name

Preferred Phone Number*

Email Address*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Please upload a recent photo

No File Chosen

File uploads may not work on some mobile devices.

If you have issues uploading a photo please contact us at CLEyentas@gmail.com. This photo is for the Yentas reference. If you want to have a different photo forwarded to potential matches, please let us know.

Upload a second photo here (optional)

No File Chosen

File uploads may not work on some mobile devices.

Birthdate*

You are

Male Female

You would like to be set-up with a*

Male Female

Are you on Facebook?*

Yes No

What is your Facebook screen name?*

Your Occupation*

How did you hear about us?*

Direct Yenta Referral Word of Mouth Facebook Flyer Scene Cleveland Jewish News

Other:

Your Height*

Your Body Type*

Athletic Average Thin Curvy Teddy Bear

Your Current City*

Your Hometown*

Your Education - where and when?*

High School, College, Graduate

Highest Degree Earned

High School Associate's Bachelor's Master's Doctoral

Other:

Are you willing to relocate?*

Yes No

Do you keep Kosher?*

Yes No

If yes, please specify your kashrut level.*

Will you eat in non-kosher restaurants?*

Yes No

Affiliation*

Reform Conservative Orthodox Unaffiliated

Other:

You are a:

Cohen Levi Israelite

You attend synogogue*

Weekly On Holidays Never

Other:

Your Status*

Never Married Divorced Widowed

Please explain why you think your last long-term relationship ended.*

How many times have you been married?*

1 2 3 or more

Please briefly explain why you think your marriage ended.*

Please briefly explain why you think your first marriage ended.*

Please briefly explain why you think your second marriage ended.

Please briefly explain why you think your third marriage ended.

When was your divorce finalized? Where is your divorce decree filed?*

When was your second divorce finalized? Where is your divorce decree filed?*

When was your most recent divorce finalized? Where is your divorce decree filed?*

If you have had a long-term relationship since your divorce, please explain why you think it ended.

If you have had a long-term relationship since your most recent divorce, please explain why you think it ended.

Please explain what you enjoyed most about your former spouse.*

If you have had a long-term relationship since you became a widow(er), please explain why you think it ended.

Please explain how your other marriage ended and when.*

Please explain how your other marriages ended and when.*

Do you have children?*

Yes No

If yes, how many and how old?*

Do you have grandchildren?*

Yes No

If yes, how many and how old?*

Do you want to have children in the future?*

Yes No Haven't thought about it

Do you want to have more children in the future?

Yes No Depends I'd be okay either way

Would you date someone else who already has children?*

Yes No

Have you ever been charged with or convicted of a felony?*

Yes No

Please explain your charge or conviction*

Do you own any pets?*

Yes No

What kind of pet do you own?*

Dog Cat

Other:

How do you feel about your potential match owning pets?*

I love pets I'm fine either way I have allergies I am not a pet person

Other:

Do you smoke?*

Yes No

Political View*

Liberal Conservative Somewhere in the Middle Doesn't Matter

What do you like to do for fun?*

What are you looking for in a match?*

What are total No's for a potential match?*

Anything else we should know?

Terms and Conditions

I certify that I am at least 18 years of age. I certify that I have completed the above form truthfully and honestly.

I understand that anyone acting as a matchmaker or Yenta on behalf of Cleveland Yentas (aka CLE Yentas) and his/her heirs, successors and assigns, any of their representatives, or agents (collectively "CLE Yentas"), does not guarantee that I will be fixed or matched up or find my beshert. CLE Yentas will make good faith efforts to find a match for me. However, I understand, acknowledge and agree that CLE Yentas is a group of people performing a mitzvah without charging a fee and not a for profit business charging a fee in exchange for matchmaking services. I understand that there may be events (e.g. matchmaking mixers) to which I may be invited to attend by CLE Yentas, which may require a fee to cover costs. I agree to abide by safe dating practices, which includes meeting first in a public location, driving separately for a first date and not operating a motorized vehicle while intoxicated. I also agree to indemnify, defend, save, and hold harmless CLE Yentas, its joint ventures and third parties for any and all harm, injury (emotional or physical) loss, costs, liabilities or expenses relating to or arising out of any suggested match or fix-up made by CLE Yentas or as a result of attending any CLE Yentas’ event (collectively, "CLE Yentas Services"). I hereby release CLE Yentas from any claims, demands and damages (actual and consequential) of every kind or nature, known and unknown, arising out of or in any way connected with anyone participating in CLE Yentas Services. I ACKNOWLEDGE THAT CLE YENTAS DOES NOT CONDUCT BACKGROUND CHECKS ON MATCHMAKING PARTICIPANTS IN ANY WAY. ANY ATTEMPT BY CLE YENTAS TO SCREEN MATCHMAKING PARTICIPANTS IS NOT A GUARANTEE OF SAFETY. I ACKNOWLEDGE THAT I AM RESPONSIBLE FOR MY OWN SAFETY WHEN MEETING OTHER MATCHMAKING PARTICIPANTS IN PERSON OR ONLINE. TO THE MAXIMUM EXTENT OF THE LAW, IN NO EVENT WILL CLE YENTAS BE LIABLE TO ME OR ANY OTHER PERSON FOR ANY INCIDENTAL, CONSEQUENTIAL, OR INDIRECT DAMAGES INCLUDING, BUT NOT LIMTIED TO, PHYSICAL DAMAGES, BODILY INURY OR EMOTIONAL DISTRESS, ARISING OUT OF THE USE OF CLE YENTAS SERVICES, INCLUDING, WITHOUT LIMITATION, DAMAGES ARISING OUT OF MY COMMUNICATION WITH AND/OR INTERACTIONS WITH ANY OTHER CLE YENTAS PARTICIPANT OR ANY INDIVIDUAL I MEET VIA CLE YENTAS.

I agree to receive notices, emails, e-newsletters, and other communications from Cleveland Yentas and its agents, until I unsubscribe in writing or electronically. I hereby grant permission to CLE Yentas to photograph me at CLE Yentas events and to use/release such photographs for any archive, grant requirement, publication or public relations purposes.

I hereby agree to the Terms and Conditions stated above. *

[clear]

Use your mouse or finger to draw your signature above

In order to keep this service free, we operate on tax-deductible donations.

Thank you to our sponsors:

The Dan and Ellen Zelman Family Foundation, a supporting foundation of the Jewish Federation of Cleveland

David and Becky Heller

Stephanie and Jared Miller

The Leonard, Lillian, Faye, Albert B. & Audrey G. Ratner Donor Advised Fund of the Jewish Federation of Cleveland

If you experience trouble completing this form, please contact us at CLEyentas@gmail.com.

Return to HOME.

*required fields