NOTE: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, driving record, lineage, and current certified medical report (including drug tests) from your doctor.
1. NAME __________ DATE OF BIRTH __________
2. HEIGHT __________ WEIGHT __________ I.Q __________ G.P.A. __________
3. SOCIAL SECURITY ______-____-________ DRIVERS LICENSE # __________
4. BOY SCOUT RANK __________
5. HOME ADDRESS ____________________________________________
CITY/STATE __________ ZIP __________
6.Do you have one MALE and one FEMALE parent? Y / N
If No, EXPLAIN ___________________________________
7. Number of years your parents have been married __________
8. Do you own a van? A truck with oversized tires? A waterbed? Do you have an earring, nose ring, belly button ring, or a tattoo? (If “yes” to any of #8, discontinue application and leave premises) __________
9. In 50 words or less, what does “LATE” mean to you?
10. In 50 words or less, what does “DON’T TOUCH MY DAUGHTER!” mean to you?
11. In 50 words or less, what does “ABSTINENCE” mean to you?
12. Church you attend __________ How often do you attend? __________
13. When would be the best time to interview your father, mother and priest/rabbi/minister? _____________________
14. Answer by filling in the blank: please answer freely. ALL answers are confidential (That means I won’t tell anyone-ever-I promise.)
a) If I were shot, the last place on my body I would want wounded is _________________
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 me about is __________
e) When I first meet a girl, the first thing I notice about her is __________
(NOTE: If your answer begins with ‘T” or “A”, discontinue. Leave premises keeping your head low. Running in a serpentine fashion is advised.)
15. 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 UNDER PENALTY OF DEATH, DISMEMBERMENT, NATIVE AMERICAN AND TORTURE, ELECTROCUTION, CHINESE WATER TORTURE, AND RED-HOT POKERS.
Signature (That means your name, moron) ______________________________
Thank you for your interest. Please allow four to six years for processing. You will be notified in writing if you are approved. Please do not try to call or write. If you do attempt any communication before your application is approved, automatic disqualification will result. If your application is rejected, you will be notified by two gentlemen wearing white ties and carrying violin cases (You might want to watch your back).
Do you still want to date my daughter?
__________ Yes, please accept my application
__________ I um, no, I uh, think I have the wrong house…