APPLICATION FOR PERMISSION TO DATE MY DAUGHTER

NOTE: This application will be incomplete and rejected unless accompanied by a complete financial statement,
job history, lineage and current medical report from your doctor.

1. Name: ____________________________________ Date of Birth: ___/___/___

2. Height: __________ Weight: __________ I.Q. _________ GPA __________

3. Social Security #: _________________ Driver License # __________________

4. Boy Scout Rank: _________________________________________________

5. Home Address: ____________________________________

City/State: _____________________ Zip: _______________

6. Next of Kin: _______________________________________

7. Sex: ___________________

(NOTE: If the answer to 7 is Yes, leave the premises, crumpling the application as you run from the property.)

YES NO

8. Do you have one (1) MALE and one (1) FEMALE Parent? ____ ____

9. Do you own a Van? ____ ____

A Truck with oversize Tires? ____ ____

A Waterbed? ____ ____

Do you have any body piercing? ____ ____

Do you have a tattoo? ____ ____

(Note: If you answered YES to any of part #9, discontinue the application and leave the premises.)

In 50 words or less, what does LATE mean to you?

__________________________________________________________________________________

In 50 words or less, what does DON'T TOUCH MY DAUGHTER mean to you?

__________________________________________________________________________________

In 50 words or less, what does abstinence mean to you? __________________________________________________________________________________

__________________________________________________________________________________

Church you attend _____________________ How Often do you attend? ______________________

When would be the best time to interview your father, mother and minister? _________________________

Answer the following questions by filling in the blank, please answer freely.
All questions will be kept confidential. (That means I won't tell anyone, I Promise)

A. If I were shot, the last place on my body I would want to be wounded is in the _________________.

B. If I were beaten, the last bone I would want broken is my __________________.

C. A woman's place is in the _____________________.

D. The one thing I hope this application does not ask about me is ____________________________.

E. When I first meet a girl, the thing I notice about her first is ________________________________.

(NOTE: If the answer to E begins with a "T" or "A", discontinue application and leave the premises, keeping your head
low and running in a serpentine fashion is advised.)

F. What do you want to be IF you grow up? _______________________________.

I SWEAR THAT ALL INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE UPON PENALTY OF DEATH, DISMEMBERMENT, NATIVE AMERICAN ANT TORTURE, CRUCIFIXION, ELECTROCUTION, CHINESE WATER TORTURE AND RED HOT POKERS.

____________________________________

Signature (That means write your name)

Thank you for your interest. Please allow four to six weeks for processing. You will be contacted in writing if you are approved. Please do not try to call or write. If your application is rejected, you will be notified by two gentlemen wearing white ties and carrying violin cases.