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PERMIT FOR PERMISSION TO DATE MY DAUGHTER This application will be incomplete and rejected unless accompanied by a complete statement of job history, lineage, and current medical report from your doctor. 1. NAME: _____________ __________ _________________ DATE OF BIRTH: ______/______/_______ 2. HEIGHT: _____________ WEIGHT: _____________ IQ: __________ GPA: _____________________ 3. DRIVERS LICENCE#: ___________________ STATE: __________ EXPIRATION DATE: ____/____/____ 4. BOY SCOUT RANK: ___________________________________ SOCIAL SECURITY#: _____-____-_____ 5. HOME ADDRESS: _____________________________ CITY/STATE: _______________ ZIP: __________ 6. Do you have one MALE and one FEMALE parent?: ___________________ 7. NUMBER OF YEARS PARENTS MARRIED?: ___________________ 8. DO YOU OWN A VAN?: ___________________ A TRUCK W/OVERSIZED TIRES?: ___________________ A WATER BED?: ___________________ TATTOO(S)?: ___________________ DO YOU HAVE AN EARRING, NOSE RING OR BELLY BUTTON RING?: _____________________________ (IF YES TO ANY OF #8, DISCONTINUE AND LEAVE PREMISES!) 9. In 50 words or less, what does DON'T TOUCH MY DAUGHTER mean to you?: ______________________ __________________________________________________________________________________ ___________________________________________________________________________________ 10. In 50 words or less what does ABSTINENCE mean to you?: ___________________________________ __________________________________________________________________________________ ___________________________________________________________________________________ 11. In 50 words or less what does LATE mean to you?: _________________________________________ ___________________________________________________________________________________ 12. Answer by filling in the blank, please answer freely - all answers confidential. (That means I won't tell anyone - ever - promise). A. If I were shot, the last place on my body I would want to be wounded is in the _______________. 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 ask me about is: ______________________________. E. When I first meet a girl, the thing I notice about her is: _________________________________. NOTE: If answer E begins with T or A, discontinue and leave premises (keeping head down and running a serpentine route is advised). 13. 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, CRUCIFIXION, CHINESE WATER TORTURE, RED HOT POKERS AND HILLARY CLINTON KISS TORTURE. __________________________________________________________ Signature (that means sign your name moron) 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.
12. Answer by filling in the blank, please answer freely - all answers confidential. (That means I won't tell anyone - ever - promise). E. When I first meet a girl, the thing I notice about her is: _________________________________. NOTE: If answer E begins with T or A, discontinue and leave premises
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