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APPLICATION FOR PERMISSION TO DATE MY DAUGHTER

NOTE: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, linage and current medical report from your doctor. Please be prepared to submit additional information (like psychological profile and polygraph test) as required.


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  1. Name:___________________________Date of Birth:______________________
  2. Height:____________ Weight:____________ I.Q.___________ GPA:_________
  3. Social Security Number:___________________ Driver's License #:____________
  4. Boy Scout Rank:___________________________________________________
  5. Home Address:____________________________ City:____________________
  6. State:____________________________ Zip Code:_______________________

    =======================================================

  7. How far can you run: 40 yards?_______________ 2 miles?___________________
  8. Do you own a? A)Van____ B)Truck with oversized tires?_____ C)Waterbed?_____
    Do you have an earring, nose ring or belly button ring?__________ Tatoo?_________
    NOTE: If you answered YES to any part of questions #8,
    discontinue the application process and leave the 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 minister?_________
  14. Answer by filling in the blanks. Please answer freely. All answers are confidential.
    (That means I won't tell anyone, ever)
    • If I were shot, the last place on my body I would want to be wounded is the__________.
    • If I were beaten, the last bone I would want broken is___________________________.
    • A Women's place is in the _________________________.
    • The one thing I hope this application does not ask me about is__________________.
    • In the unfortunate event of my untimely death, I would like______________to be contacted.
    • My greatest fear is__________________________________________.
    • When I first meet a girl, the first thing I notice about her is her___________________.
      NOTE: If the answer to the last question begins with a "B",
      discontinue the application process and leave the premises.
      Keep your head low and running in a serpentine fashion is advised.
  15. What do you want to be "IF" you grow up?____________________________
  16. Have you ever been fingerprinted?______ Had a DNA sample taken and recorded?_________
  17. Your dentist is__________________ Emergency phone #_________________________

I SWEAR THAT ALL INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT,
UNDER PENALTY OF DEATH, DISMEMBERMENT, NATIVE AMERICAN ANT TORTURE,
ELECTROCUTION, CHINESE WATER TORTURE AND/OR HOT POKERS.
Signature________________________

Thank you for your interest. Please allow 4-6 years for processing.
You will be contacted in writing if you are approved.
Please do not try to call or write.
(It could cause disqualification and injury to your body.

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