APPLICATION FOR PERMISSION TO DATE MY
DAUGHTER
NAME___________________________________________________________
DATE OF BIRTH___________________________________________________
HEIGHT____________ WEIGHT________ I.Q.________G.P.A. ____________
SOCIAL SECURITY NUMBER____________________ ___________________
DRIVER'S LICENSE NUMBER _______________________________________
BOY SCOUT RANK ________________________________________________
HOME ADDRESS _________________________________________________
CITY ____________________________________________________________
STATE ___________________________
1. Do you have one MALE and one FEMALE parent? __________
2. If NO, explain _________________________________________________________________
3. Number of years parents married _____________
4. Do you own a VAN______ Truck with oversized tires _______ Waterbed______
5. Do you have an Earring ______ nose ring ______ belly button ring _______
engagement ring ________ __________
6. In 50 words or less, what does LATE mean to you? ________________________
_________________________________________________________________
_________________________________________________________________
7. In 50 words or less, what does DON'T TOUCH MY DAUGHTER mean to you?
_________________________________________________________________
_________________________________________________________________
8. In 50 words or less, what does ABSTINENCE mean to you? _________________________________________________________________
_________________________________________________________________
_________________________________________________________________
9. Church/Synagogue you attend __________________________________________________
10. How often? ________________________________________________________________
11. When would be the best time to interview your parents? ___________________________
12. Your Minister/Priest/ Rabbi __________________________________________________
Please answer the following. All questions will be kept confidential unless I feel you are a threat to my daughter, in which case a full page ad will be taken out in the local newspaper.
13. If I were shot, the last place on my body I would want to be shot in is________________
14. A woman's place is in the _____________________________________________________
15. The one thing I wish this application does NOT ask is _____________________________
16. When I first meet a girl, the thing I notice FIRST about her is ______________________ (if the answer to this question starts with a B, leaving the premises, keeping your head low and running in a serpentine matter is advised.)
17. What do you want to be IF you grow up? _______________________________________
I swear that all answers supplied are true and correct to the best of my abilities, under penalty of death.
SIGNATURE _________________________________________________________________
Thank you for your interest in my daughter. Please allow 4 years for processing. You will be contacted in writing by either myself, via e-mail, or by summons, via sheriff deputy.