APPLICATION FOR PERMISSION TO DATE MY DAUGHTER


NAME: _________________________________________________________

DATE OF BIRTH:____________________________

HEIGHT:_________     WEIGHT:________     I.Q.: _________  GPA:  ________

COLLEGE AFFILIATION:_____________________

SOCIAL SECURITY #_________________

DRIVERS LIC/STATE:__________________  Boy Scout Rank:  _________________

Home address:  _______________________________

City/State/Zip: __________________________________________________

Name and address of Nearest
Relative not incarcerated: ______________________

City/State/Zip:__________________________________________________

Church Membership:  Date initiated:_______________  

Attendance: _______________________  Annual Tithe:  __________
							circle one	
Do you have ONE MALE and ONE FEMALE parent?  yes     no

If NO,       please explain: ______________________________

Do you own a van?   yes     no     Truck with oversize tires?   yes    no

Waterbed?   yes   no   Live in a trailer?   yes  no


Do you have any of the following: [[circle any or all that apply]]
earring    nosering    facial piercings   naval piercings     body piercings      tattoo


Do you have any relatives with the following: [[circle any or all that apply]] 
Heart disease   mental illness    living as a vegetable    diabetes     AIDS__

I.Q. of less than 50     missing teeth     suffering from
dwarfism/giantism     addiction to alcohol/smoking/bowling/hunting_

In 25 words or less, what does LATE mean to you.
________________________________________________________________

In 25 words or less, what does ABSTINENCE mean to you.
_________________________________________________________

In 25 words or less, what does "DON'T TOUCH MY DAUGHTER" ...
mean to you ?
_________________________________________

Please answer the following by filling in the blanks:
All answers are confidential (Maybe)

1)     If I were shot, the last place on my body I would want
to be wounded is:
___________________________________________

2)     If I were beaten, the last bone I want broken is:
____________________________ Why?____________________________

3)     A woman's place is:
____________________________________________________________

4)     The one thing I hope this application does not ask me about is:
________________________________________________

5)     When I meet a girl, the first thing I notice is:
__________________________
       second thing I notice is: _________________

6)     What do you want to be IF you grow up?
____________________________________________________________________


Character: [it better be]
Standing up for what you believe in, despite the personal cost.


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, CURCIFIXION, ELECTROCUTION, CHINEESE WATER TORTURE,
DRAWING & QUARTERING, AND RED-HOT POKERS.

X_________________________________________________
    Signature
Thank you for your interest.  Please allow 4-6 years for processing.
Don't call us, We'll call you.  Any mis-truths will disqualify you from
apply again for 10 years. 


NOTE:  	This application will be incomplete and rejected unless
accompanied by a complete income statement, job history, lineage, and
current medical report from your doctor.

















































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