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Bad Date Report
Please complete the form below.
Community Partner Information
Partner Name
(Required)
Staff/Volunteer Name
Submitter Information (Optional)
Name
First
Last
Email
(Required)
Date Submitted
YYYY slash MM slash DD
Incident
Time of Incident
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Date of Incident
(Required)
YYYY slash MM slash DD
Location of Incident
(Required)
PIcked Up By
(Required)
Foot
Car
Truck
Bicycle
Other
How Was Date Arranged
(Required)
Street
Parlour
Online
Description of Incident
(Required)
Do you want to report this to the police?
(Required)
Yes
No
Would you like this to appear as public alert?
(Required)
Yes
No
Description of Vehicle
Colour
License Plate
Number of Doors
Two
Four
Sliding doors
Condition
Old
New
Damaged
Make/Model
Acura
Audi
BMW
Buick
Cadillac
Chevrolet
Chrysler
Dodge
Ford
GMC
Honda
Hyundai
Infiniti
Isuzu
Jaguar
Jeep
Kia
Land Rover
Lexus
Lincoln
Mazda
Mini
Mercedes Benz
Mercury
Mitsubishi
Nissan
Pontiac
Porsche
Saab
Saturn
Scion
Subaru
Suzuki
Tesla
Toyota
Volvo
VW
Type
Sedan
Hatchback
Sports car
Convertible
Station wagon
SUV
Minivan
Panel van
Pickup truck
Cube truck
Description of Suspect
Suspect Name
First
Last
Age
Hair Colour/Type
Height/Weight/Build
Tattoos & Scars
Nationality
Smells
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