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Application to Date my Daughter

1. What is your name, age, social security number, IQ and boy scout rank?

2. Do you own or have access to a van? ____

3. A truck with oversize tires? ____

4. waterbed? ____

5. Do you have an earring, nose ring, or belly button ring? ____

6. Do you have a tattoo? ____

If you have answered YES to #3, #4 or #5, discontinue application and leave immediately.*

7. In fifty words or less, what does LATE mean to you?

8. In fifty words or less, what does DON'T TOUCH MY DAUGHTER mean to you?

9. In fifty words or less, what does ABSTINENCE mean to you?

10. In fifty words or less, what does REAL PAIN mean to you?

11. Church/Temple you attend: ____________________________

12. How often do you attend: ____________________________

13. When would be the best time to interview your mother, father and priest/rabbi? ____________________________

14. Please fill in the blanks:

If I were shot, the last place on my body I would want wounded would be ____________________________

If I were beaten, the last bone I would want broken would be ____________________________

The one thing I hope this application doesn't ask is ____________________________

What do you want to be IF you grow up?

I swear that all the above information is correct to the best of my knowledge under penalty of death, bodily harm, dismemberment, torture or mental abuse.

Signature of applicant _________________________________

Signature of father _____________________________________

Signature of mother ____________________________________

Signature of priest/rabbi ___________________________________

Signature of State Representative _________________________