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PLEASE ANSWER FREELY. ALL ANSWERS ARE CONFIDENTIAL
This application will be incomplete and rejected unless accompanied by a complete financial statement, school history, job history, ancestral lineage, DMV printout, and a current medical report from your doctor.
NAME ______________________________________________________________
DATE OF BIRTH ___________________ HEIGHT ________ WEIGHT ____________
IQ ______ GPA _______ SOCIAL INSURANCE NO. ________________________
DRIVERâS LICENCE NO. ________________________
HOME ADDRESS _____________________________________________________
HOME PHONE _________________________________
Do you have at least one male and one female parent? If no, please explain.________________________________
No. of years they have been married. If less than 10, please explain. ________________
Do you own a van?__________ A truck with oversize tires? _________________
A waterbed? ___________________ A Pick-up with a mattress in the back? _____________
A condom? ____________ Pornography? _________________________
IF YOU ANSWERED YES TO ANY OF THE ABOVE, DISCONTINUE WITH THE APPLICATION AND LEAVE THE PREMISES.
In 50 words or less, what does LATE mean to you? _____________________________
In 50 words or less, what does DONâT TOUCH MY DAUGHTER mean to you? __________________________________________________
In 50 words or less, what does ABSTINENCE mean to you? ______________________
What church do you attend? How often? _____________________________________
When would be the best time to interview your father? mother? priest? Parole officer?
If I were shot, the last place I would want shot would be: ________________________
If I were beaten, the last bone I would want broken is my: _______________________
A womanâs place is in the _________________________
The one thing I hope this application does not ask me is _______________________
When I first meet a girl, the thing I notice about her first is : _______________________________ NOTE: If the answer begins with T or A discontinue immediately and leave premises.
What do you want to do if you grow up? ________________________
What is the current rate of a motel room? __________________ How come you know? _______________
Condoms come packaged in ___3 ____5 _____6 _____12 How come you know? ______________________________________________
I SWEAR THAT ALL THE INFORMATION SUPPLIED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT, NATIVE AMERICAN ANT TORTURE, CRUCIFIXION, ELECTROCUTION, CHINESE WATER TORTURE, RED HOT POKERS, AND HILLARY CLINTON KISS TORTURE.
SIGNATURE__________________________ DATE___________________
ALLOW 48 WEEKS FOR PROCESSING.
This application will be incomplete and rejected unless accompanied by a complete financial statement, school history, job history, ancestral lineage, DMV printout, and a current medical report from your doctor.
NAME ______________________________________________________________
DATE OF BIRTH ___________________ HEIGHT ________ WEIGHT ____________
IQ ______ GPA _______ SOCIAL INSURANCE NO. ________________________
DRIVERâS LICENCE NO. ________________________
HOME ADDRESS _____________________________________________________
HOME PHONE _________________________________
Do you have at least one male and one female parent? If no, please explain.________________________________
No. of years they have been married. If less than 10, please explain. ________________
Do you own a van?__________ A truck with oversize tires? _________________
A waterbed? ___________________ A Pick-up with a mattress in the back? _____________
A condom? ____________ Pornography? _________________________
IF YOU ANSWERED YES TO ANY OF THE ABOVE, DISCONTINUE WITH THE APPLICATION AND LEAVE THE PREMISES.
In 50 words or less, what does LATE mean to you? _____________________________
In 50 words or less, what does DONâT TOUCH MY DAUGHTER mean to you? __________________________________________________
In 50 words or less, what does ABSTINENCE mean to you? ______________________
What church do you attend? How often? _____________________________________
When would be the best time to interview your father? mother? priest? Parole officer?
If I were shot, the last place I would want shot would be: ________________________
If I were beaten, the last bone I would want broken is my: _______________________
A womanâs place is in the _________________________
The one thing I hope this application does not ask me is _______________________
When I first meet a girl, the thing I notice about her first is : _______________________________ NOTE: If the answer begins with T or A discontinue immediately and leave premises.
What do you want to do if you grow up? ________________________
What is the current rate of a motel room? __________________ How come you know? _______________
Condoms come packaged in ___3 ____5 _____6 _____12 How come you know? ______________________________________________
I SWEAR THAT ALL THE INFORMATION SUPPLIED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF DEATH, DISMEMBERMENT, NATIVE AMERICAN ANT TORTURE, CRUCIFIXION, ELECTROCUTION, CHINESE WATER TORTURE, RED HOT POKERS, AND HILLARY CLINTON KISS TORTURE.
SIGNATURE__________________________ DATE___________________
ALLOW 48 WEEKS FOR PROCESSING.
