Name: Last___________First______________ M. Initial_______ Age______
Address: ________________________________County______________________
Religion: ________________________#Attendance’s in the Last Year_____
Parents: Father’s Name________________#Marriages______#Years_________
Address________________________________________________
Mother’s Name_______________#Marriages______#Years_____
Address________________________________________________
1. Do you own or drive a Van? ______________ (If so Please Discontinue
Filling Out Form)
2. In 50 words or less, describe what NO!!!! Means to you_________
__________________________________________________________________
__________________________________________________________________
3. In 50 words or less, describe what LATE!! Means to You_________
__________________________________________________________________
__________________________________________________________________
4. Where would you least like To Be SHOT?_________________________
5. Which is the Last BONE You Want Broken?________________________
6. What do you want to be IF you grow up?_________________________
7. The Place for a WOMAN Is?______________________________________
8. What is MY Daughter’s NAME? ___________________________________
9.Who besides GOD Should YOU FEAR the most? ______________________
Parental Use Only:
Appearance Looks Like:Status:
Mel Gibson ___________Accepted:__________
David Letterman_______Rejected: __________
Pee-Wee Herman________Pending: __________
NOTE: This application will be incomplete and rejected unless accompanied
by a complete financial statement, job history, lineage, and current
medical report from your doctor.
NAME______________________________________ DATE OF BIRTH_____________
HEIGHT____________ WEIGHT_____________ IQ__________ GPA_____________
SOCIAL SECURITY #____________________
DRIVERS LICENSE #_______________
BOY SCOUT RANK AND BADGES_____________________________________________
HOME ADDRESS__________________________
CITY/STATE___________ ZIP_____
Do you have ONE male and ONE female parent?__________
If NO, explain________________________________________________________
Number of years married________ If less than your age, Explain________
________________________________________________________________
Do you own a van?_____ A truck with oversized tires?_____
A waterbed?_________ A pickup with a mattress in the back?______
A condom?______ Pornography?_______
Do you have earring, nose ring, or a belly button ring?________
A tattoo?___________ (IF YES TO THE ABOVE, DISCONTINUE APPLICATION AND
LEAVE PREMISES)
In 50 words or less, what does DON’T TOUCH MY DAUGHTER, mean to you?
_______________________________________________________________
________________________________________________________________
In 50 words or less, what does ABSTINENCE mean to you?
________________________________________________________________
________________________________________________________________
When would be the best time to interview your father, mother, and
priest?_____________
Answer by filling in the blank. Please answer freely, all answers are
confidential. (that means I won’t tell anyone EVER)
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 above answer begins with T or A, discontinue. Leaving premises
keeping your head low and running in a serpentine fashion is advised.
What is the current going rate of a hotel room? _______________________
Condoms come in packages of
A: 3 B: 6 C: 9 D: 12 E: ALL OF THE ABOVE (circle one)
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, CRUCIFIXION, 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 contacted in writing if you are approved. Please
do not try to call or write.
If your application is rejected, you will be notified by two gentleman
wearing white ties carrying violin cases (you might watch your back).