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The Purpose of This Interaction

It can be difficult to initiate contact in when you feel vulnerable or at risk of being ignored 

I am initiating contact because I want to:  

Examples :

  • Get to know you better

  • Take you out to dinner

  • Go for a walk

Facts and Hopes About Our Interaction

Establishing a genuine human connection in this cyber/social media world is an exception not the norm. real connections require openness and courage

  • I hope you give me a chance

  • I hope you see me as a fearless and genuine human who took a leap

  • Either way no hard feelings!

Terms & Conditions of This Interaction
  • The risks, benefits, “side effects” and alternatives of using this Z Form are assumed and understood by me.

  • The content of this Z Form is an accurate representation of my emotional experience and what I intend to communicate to you.

  • I understand that I may terminate the interaction at any time and that you are also entitled to do the same by revoking this consent.

  • I understand that this interaction may not be politically correct.  


Z Form is not responsible in any way of how you chose to use this form. It may provide peace of mind for constructive dialogue for any style of interaction. Both parties assume responsibility for the use and outcome(s) resulting from this form. Once both parties agree to the interaction, it is solely up to the parties to organize/plan how to proceed. 

Information and Signature

My signature below attests that and that I am not being coerced or threatened, that I am in a sound state of mind and I am not under the influence of substances legal or illegal. I understand and agree with all the above statements. By proceeding with the use of this form, I am consenting to all of the above. 


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