APPLICATION FOR PERMISSION TO DATE MY DAUGHTER

note: This application will be incomplete and rejected unless accompanied by a complete financial statement,,job history, linege and current medical report from your physician.

Name:___________________
Date of Birth_____________
Height:_________
Weight_______
IQ:_______
GPA_______
Social Security Number____________
Driver License_____
Boy Scout Rank:________
Telephone:_________________
Home Address:______________
State_____
ZIP:__________

1. Do you have one male and one female parent?_____
If “No”, explain:

2. Number of years parents have been married:______
Any brothers or sisters?______
Are they normal?_________

3. Do you own or have access to a van?_________
A truck with oversize tires?__________
A waterbed?__________

4. Do you have a tatto?_________

5. Do you have an earring,nose ring,or belly button ring? _______

if you answered YES to #3, #4, or#5, discontinue application and leave immediately.

6. In fifty word or less, what does LATE mean to you?

7. In fifty words or less,what does DON’T TOUCH MY DAUGHTER mean to you?

8. In fifty words or less , what does ABSTINENCE mean to you?

9. In fifty words or less,what does REAL PAIN mean to you?

10. Church/Temple you attend:_________________

11. When would be the best time to interview your mother, father and clergy__________________________

12. Please fill in the blanks:

a. If I were shot, the last place on my body I would want wounded would be my_________________

b. If I were beaten, the last bone I would want broken would be my__________________

c. A woman’s place is in the_______________

d. The one thing I hope this application doesn’t ask__

e. When I meet a girl, the one thing I always notice about her first is_____________________

Note: If answers with “T” or”A” discontinue and leave premises-keeping your head low and running in a serpentine fashion is advised

13. What do you want to be if you grow up?

I swear that all the above information is correct to the best of my knowledge under penalty of death, bodily harm, dismemberment, torture or mental abuse.

Signature of applicant___________________________

Signature of father_______________________________

Signature of mother_____________________________

Signature of clergy_______________________________

Signature of State Representative_____________________

Thanks you for the interest, and it had better be genuine and non-sexual. Please allow 4-6 years for processing.You will be contacted in writing if approved. If denied,please never apply again. Don’t call me, I’ll call you.