Dating Form

For those with daughters:

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.

1. Name:_____________________Date of birth:______________

2. Height: _______ Weight: _______I.Q.: __________ Annual Earnings: ______

3. Social Security #: ____________Drivers License #: ___________

4. Boy Scout Rank: ____________________

5. Home Address: _____________________________________________

    Town/County: ____________ PostCode: ___________

6. Do you have one MALE and one FEMALE parent ? __________

If NO, explain:

_______________________________________________________

7. Number of years parents married: __________

8. Do you own:

• a van ? _____


• a truck with oversized tires ? ________


• a waterbed ? __________


• Do you have an earring, nose ring, belly button ring,
  or nipple ring ? __________


• Do you have tattoos and/or long hair? ____________


• (If YES to any of #8, Discontinue application and LEAVE quickly)

9. In 50 words or less, what does LATE mean to you ?

________________________________________________________

________________________________________________________

10. In 50 words or less, what does DON'T TOUCH MY DAUGHTER mean to you ?

________________________________________________________

________________________________________________________

11.In 50 words or less, what does ABSTINENCE mean to you ?

________________________________________________________

________________________________________________________

12. What Church do you attend: ___________________

      How often do you go?_____________

      Who can verify this? _____________________

13.When would be the best time to interview;

      Your father: _________

      Your mother: ____________

      Your priest ? ______________

14. Answer by filling in the blank:
     Please answer freely - All answers are confidential
     (That means I won't tell anyone -ever -I 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 _______________________.

D. The one thing I hope this application does not ask me about is
     __________________________________.

E. When I meet a girl the thing I notice about her first is
     ______________________.
     (Note: If answer E begins with "T" or "A", discontinue Application and
     get the %$#@ off of my property keeping your head low and running in a
     serpentine fashion to avoid gunfire.)

15.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, INDIAN ANT TORTURE, ELECTROCUTION, CHINESE WATER TORTURE, RED HOT POKER TORTURE, IF I AM LUCKY.

____________________________ (Signature) ______________(Date)

Thank you for your interest. Please allow up to six years for processing. You will be contacted in writing if you are approved.

Please do not try to call or write.

**************FOR PARENTAL USE ONLY*********************

Date Rejected:______________