Questionnaire for customers:

Mother's full name and date of birth _________

Father's full name and date of birth  __________

What names you were thinking of naming the child before deciding to go to Gabooldra? _______________

If you know it, what is the sex of the child? _____________

If the child was conceived naturally, can you pinpoint the instance of intercourse leading to child's conception? If so, please describe the smells in the room (continue on to a separate sheet of paper, if necessary) ______________

Is this your first child? If not, please list siblings' names ______________

Are you a citizen of New Zealand, Sweden, or the Dominican Republic? If so, please stop completing the questionnaire. ________

If you had to change your own name, to what would you change it? _________________

Would you describe your eating habits as nutritious, fairly nutritious, or not nutritious at all? __________

Are you overweight? _____________

Please list your occupation and level of education ______________________

Would you describe your soul as old, young, or middle aged? _____________________

Please list any unusual cravings and urges (food-related or otherwise) the mother has experienced while pregnant ________________

Does the child kick/move frequently within the uterus? _________________

If you were forced to chose, would you name your child Hitler or Diarrhea? No or alternate spellings or nicknames are allowed. __________

What was your combined household income last year? ______________________

Have you ever been convicted of plagiarism by an instructor, school ethics board, or court of law? ___________

How did you hear about Gabooldra? ______________________


If you are purchasing a name for a pet, please email me for a separate questionnaire.