APPLICATION FOR PERMISSION TO DATE MY DAUGHTER

NOTE: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, copy of signed Teenager Driving Contract, and current medical report from your doctor.

NAME: _______________________________________

DATE OF BIRTH: ________________________

HEIGHT: ________   WEIGHT: _________

HAIR COLOR:  __________  EYE COLOR: _________

BIRTHMARKS: _________________________________

IQ: _________  GPA:  ______________

SOCIAL SECURITY #:  _________________________

DRIVER'S LICENSE #: _________________________

BOY SCOUT RANK AND BADGES: __________________

_____________________________________________

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SCHOOLS ATTENDED: ___________________________

_____________________________________________

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EXTRACURRICULAR ACTIVITIES: _________________

_____________________________________________

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HOME ADDRESS: _______________________________

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CITY/STATE: _________________________________

___________________________  ZIP: __________

TELEPHONE: _________________________________

EMAIL: _____________________________________

Do you own a van? ____ A truck with oversized tires? ____

A waterbed? ____ A pickup with a mattress in the back? ____

A pager? _____

Do you have an ear ring, a nose ring, or a belly button ring? ____

A tattoo? ____
(IF YES TO ANY OF the ABOVE, DISCONTINUE APPLICATION AND LEAVE PREMISES.)

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

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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?

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Church you attend: ________________________________________

How often you attend: _____________________________________

When would be the best time to interview your father, mother, and pastor? ______________

Answer by filing in the blank. Please answer freely. All answers are confidential (that means I won’t tell anyone EVER).

A. If I were shot, the last place I would want to be shot would be _____________________

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

C. The one thing I hope this application does not ask me about is ______________________

D. When I meet a girl, the first thing I notice about her is ____________________________

(IF ANSWER to D. BEGINS WITH “T” OR “A”, DISCONTINUE APPLICATION AND LEAVE PREMISES IMMEDIATELY.)

What do you want to do IF you grow up? ___________________

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I SWEAR THAT ALL INFORMATION SUPPLIED ON THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT, ELECTROCUTION AND RED HOT POKERS.

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SIGNATURE  (that means your name)

Thank you for your interest. Please allow four to six years 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 gentleman wearing white ties and carrying violin cases.

(Source unknown)