Application For Permission to Date My Daughter

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 _____________ WEIGHT _____

2. IQ_________________ G.P.A._________

6. Do you have one MALE and one FEMALE parent? YES________ NO________

If no, explain

7. Number of years your parents have been married

8. Do you own a van? Yes ___No ___ A truck with oversized tires? Yes___ No ___

A waterbed? Yes ___No ___

Do you have an earring, nose ring or belly button ring? Yes ___ No ___ A tattoo? Yes ___No ___

(If yes to any of #8, discontinue application and leave premises)

11. In 50 words or less what does abstinence mean to you?

12. Church you attend____________________________ How often do you attend? _______________

14. Answer by filling in the blanks: please answer freely. ALL answers are confidential (this means I won’t tell

anyone.—ever—I promise)

1) If I were shot, the last place on my body I would want wounded is _________________________

NOTE:If your answer begins with “T” or “A” discontinue. Leave premises; keeping your head low and run.

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 ant torture, electrocution, Chinese water torture or red hot pokers.

Signature________________________________________________________