APPLICATION FOR PERMISSION TO DATE MY DAUGHTER
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NOTE: This application will be incomplete and rejected unless accompanied
by a complete financial statement, job history, driving record, lineage, and
current certified medical report (including drug tests) from your doctor.
1. NAME _______________________________ DATE OF BIRTH ________________
2. HEIGHT ______________ WEIGHT __________ I.Q _______ G.P.A.____________
3. SOCIAL SECURITY # _____________ DRIVERS LICENSE # __________________
4. BOY SCOUT RANK____________________________________________________
5. HOME ADDRESS _________________ CITY/STATE ___________ ZIP __________
6. Do you have one MALE and one FEMALE parent?______________________________
If No, EXPLAIN ______________________________________________________
7. Number of years your parents have been married ________________________________
8. Do you own a van? ______ A truck with oversized tires? ______ A waterbed? _________
Do you have an earring, nose ring, belly button ring, or a tattoo? _____________________
(If "yes" to any of #8, discontinue application and leave premises)
9. In 50 words or less, what does "LATE" mean to you?______________________________
_______________________________________________________________________
10. In 50 words or less, what does "DON'T TOUCH MY DAUGHTER" mean to you?
_______________________________________________________________________
_______________________________________________________________________
11. In 50 words or less, what does "ABSTINENCE" mean to you? ______________________
_______________________________________________________________________
12. Church you attend _____________ How often do you attend ______________________
13. When would be the best time to interview your father, mother and priest/rabbi/minister? ____
14. 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 wounded is __________________
b) If I were beaten, the last bone I would want broken is my ________________________
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 first thing I notice about her is _______________________
( NOTE: If your answer begins with "T" or "A", discontinue. Leave premises keeping your
head low. Running in a serpentine fashion is advised.)
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,
AND RED HOT POKERS.
________________________________________
Signature (That means sign your name)
Thank you for your interest. Please allow four to six years for
processing. You will be notified in writing if you are approved. Please do
not try to call or write. If you do attempt any communication before your
application is approved, automatic disqualification will result.
If your application is rejected, you will be notified by
two gentlemen wearing white ties and carrying violin cases (You might
want to watch your back).
Do you still want to date my daughter?:
_____ Yes, please accept my application
_____ I um, no, I uh, think I have the wrong house...
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