APPLICATION

FOR PERMISSION TO DATE MY DAUGHTER

Note: This application will be judged to be incomplete unless accompanied by a complete financial statement, certified copy of applicant’s birth certificate, and complete medical report from a doctor of my choosing.

NAME: DATE OF BIRTH: ________

HEIGHT: WEIGHT: IQ: GPA ______

SOCIAL SECURITY NO.______-___-_____ DL #: ___________

BOY SCOUT RANK: _____ SUNDAY SCHOOL ATTENDED_____

Do you have one MALE and one FEMALE parent? _____

(If not, explain on back of this application.)

Number of years parents married_____ Brothers or sisters___________

Are your brothers and sisters “normal”___(If not explain on back)

Do you own or have access to:

A VAN?_____

A TRUCK WITH OVERSIZED TIRES?____

A WATERBED?_____

Are any parts of your body pierced?_____ If yes, where_____________

Do you have a tattoo?______ If yes, where and what design___________

In 50 words or less, what does the word LATE mean to

you? ______________________________________________________

___________________________________________________________

In 50 words or less, what do the words “Don’t touch my daughter mean to you? _______________________________________________________

In 50 words or less, what does the word NO mean to you? ____________

___________________________________________________________

In 50 words or less, give your definition of Real Pain. ______________

___________________________________________________________

Church you attend: How often? 5, M, TU, W, Th, F, S

When would be the best time to interview your mother and father?____ ___

Please fill in the blank:

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_______________________

D) The one thing I hope this application doesn ‘t ask is

E) When I meet a girl, the first thing I always notice is her _________

F) What do you want to be if you grow up? ________________

I swear that the above information is true and accurate to the best of my knowledge, under penalty of bodily harm, torture or dismemberment.

Signature of Applicant: __________________________

Signature of Parent: _______________________________

Signature of Minister: ___________________________________

Signature of Scout Master: _______________________________

Thank you for your interest in dating my daughter. Please allow 4-6 weeks for processing. You will be contacted in writing if approved. If denied, do not bother to re-apply or contact my daughter in any way.