APPLICATION FOR PERMISSON TO DATE MY DAUGHTER
NOTE: This application will be incomplete and rejected unless accompanied by a complete
financial statement, job history and current medical report from your doctor.
1. Name _____________________________________ Date of Birth ______________________
2. Height _______________ Weight ______________ I.Q. ________ G.P.A. ________________
3. Social Insurance Number ________________ Driver’s License Number ________________
4. Boy Scout Rank ______________________________________________________________
5. Home Address _______________________________________________________________
6. Do you have one Male and one Female parent? Yes ___ No ___
If No, Please explain __________________________________________________________
7. Number of Years Parents Married: ______________
8. Do you own a car? Yes ___ No ___ truck with oversize tires? Yes ___ No ___
9. Do you have an earring, nose ring or bellybutton ring? _____________________________
10. In 50 words or less, what does Late mean to you?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
11. In 50 words or less, what does Don’t Touch My Daughter mean to you?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
12. In 50 words or less, what does Abstinence mean to you?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
13. What church do you attend? _______________________ How often? _____________________
14. When would be the best time to interview your Father? ________________________________
Your Mother? ____________________________________________________________________
15. Answer by filling in the blanks. (Please answer freely.) All answers are confidential:
a) If I were shot, the last place on my body I would like to be wounded is ______________________
b) If I were beaten, the last bone I would want broken is______________________________________
c) A woman’s place is in the _____________________________________________________________
d) The one thing I hope this application does not ask me about is ____________________________
e) When I first meet a girl, the first thing I notice about her is ________________________________
NOTE: If answer begins with T or A, discontinue and leave the premises, keeping head
low and running in a serpentine pattern is advised.
16. 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, Crucification, Electrocution, Chinese
Water Torture and Hilary Clinton Kiss Torture.
_______________________________ ____________________________________________
Date Signature
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