APPLICATION FOR PERMISSION TO DATE MY DAUGHTER
Print out and submit as per instructions at the bottom of the form.
1. Name :______________________ Date of Birth :______________
2. Height :___________________________
Weight :_______________________ GPA :________________
3. Social Sec. #_________________ Drivers
license#_____________________
4. Boy Scout Rank :__________________________
5. Home address :_______________________ City/ State_____________
6. Do you have one male and one female parent ? Yes _______ No _______
7. If no, explain :______________________________________________
8. Number of years parents married :_____________________________
9. Do you own a van ?______ A truck with oversized tires ?____
A water bed ?_______
10. Do you have an earring , nose ring , belly-button ring ?______ A tattoo ?_______
(If yes to any of #9 or #10, Discontinue application and leave premises …)
11. In ten words or less, what does LATE mean to you ?
___________________________________________
12. In ten words or less, what does Abstinence mean to you ?
______________________________________
13. In ten words or less, what does DON’T TOUCH MY DAUGHTER mean to you?
___________________________________________________
14. Church you attend :__________________ How often you attend :_____
15. When would be the best time to interview your Father, Mother, And Pastor ?
___________________
16. What would you want to be IF you grew up ?
_______________________________________________
Answer by filling in the blanks. Please answer freely – all answers are confidential (that I won’t tell anyone – ever- I promise).
If I were shot, the last place on my body I would want wounded is in the
__________________________
If I were beaten the last bone I would want broken is my
________________________________________
The one thing I hope this application does not ask me about is
___________________________________
When I first meet a girl, the thing I notice about her first
is_______________________________________
(Note: If answer begins with T or A, discontinue and leave premises: Keeping your head low and running in a serpentine fashion is advised. )
I SWEAR THAT THE INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF: NATIVE AMERICAN ANT TORTURE, ELECTROCUTION, CHINESE WATER TORTURE, RED HOT POKERS, DEATH, AND DISMEMBERMENT.
Signature (that means your name, moron)
______________________________________________________
Thank you for your interest. Please allow 4 to 6 weeks for processing. You will be contacted in writing if you are approved. Please do not attempt to call or write. If your application is rejected you will be notified by two gentlemen wearing white coats and carrying a violin case.
APPLICANT’S RIGHT THUMB PRINT IN BLOOD
Broken Believers 