APPLICATION FOR PERMISSION TO DATE MY DAUGHTER
Note: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, ancestral lineage, and current medical report from your doctor.
1.NAME: __________________________________________________ Date of Birth: ______________________________
2.Height: __________ WEIGHT: __________ IQ: _________ G.P.A. ___________
3.YEAR IN SCHOOL: _____ or, IF GRADUATED YR. COMPLETED:_____ SCHOOL NAME: ________________________
4.SOCIAL SECURITY #: _____-_____-_____ DRIVER’S LICENSE #:______________________________ STATE:_______
5.BOY SCOUT RANK: _________________________________________________________________________________
TROOP LEADER’S NAME & TELEPHONE NUMBER:______________________________________________________
6.HOME ADDRESS: ________________________________ CITY: __________________STATE: ____ ZIP CODE: ______
7.NAME OF POLICE CHIEF IN HOME TOWN: ______________________ PHONE NUMBER: _______________________
8.Do you have one MALE and one FEMALE parent? _________ yes/no
If no, explain: _______________________________________________________________________________________
__________________________________________________________________________________________________
9.Number of years parents married: ______________
10.Do you own a van? ____ A truck with oversized tires? ____ A waterbed? ___Tattoo?____Do you have an earring? ____
Nose ring? ____ Belly button ring? ____ Other piercing? ____
(IF YOU ANSWERED YES TO ANY OF #10, DISCONTINUE APPLICATION AND LEAVE PREMISES FOREVER!)
11.In 20 words or less what does LATE mean to you? _________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
12.In 20 words or less what does ABSTINENCE mean to you? __________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
13.In 20 words or less, what does DON’T TOUCH MY DAUGHTER mean to you?____________________________________
_______________________________________________________________________________________________________
14.What Church do you attend? ____________________________ How often?_____________________________________
Pastor’s name? _______________________________ Phone number? ________________________________________
15.When would be the best time to interview your father, mother, and pastor?_______________________________________
16.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 to be wounded is in the_______________________________________________.
B.If I were beaten, the last bone I would want broken is the_______________________________________________________________.
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 thing I notice about her first is: ____________________________________________________________.
(Note: If answer E begins with “T” or “A”, discontinue the application and leave the premises FOREVER. Also note, keeping your head low and running in a serpentine
fashion is highly recommended!)
17.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 ANT TORTURE, CRUCIFIXION, ELECTROCUTION, CHINESE WATER TORTURE, RED HOT POKERS, AND HILARY CLINTON KISS TORTURE.
Signed: ________________________________________________________
(That means your name, MORON)
Thank you for your interest. Please allow 4 to 6 years for processing. You will be contacted in writing if your application is approved. Please do not try to call or write (since you probably can’t, and it would cause you injury.) If your application is rejected you will be notified by two gentlemen wearing white ties, white shoes, black suits and carrying violin cases (you might want to watch your back and keep your doors and windows locked).
