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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.
NAME_____________________________________ DATE OF BIRTH_____________
HEIGHT___________ WEIGHT____________ IQ__________ GPA_____________
SOCIAL SECURITY #_________________ DRIVERS LICENSE #________________
BOY SCOUT RANK AND BADGES__________________________________________
HOME ADDRESS_______________________ CITY/STATE___________ ZIP______
Do you have parents? ___Yes ___No
Is one male and the other female? ___Yes ___No
If No, explain: __________________________________________________ ___________
__________________________________________________ ___________________
Number of years they have been married ______________________________
If less than your age, explain
__________________________________________________ __________________
__________________________________________________ __________________
ACCESSORIES SECTION:
A. Do you own or have access to a van? __Yes __No
B. A truck with oversized tires? __Yes __No
C. A waterbed? __Yes __No
D. A pickup with a mattress in the back? __Yes __No
E. A tattoo? __Yes __No
F. Do you have an earring, nose ring, __Yes __No
pierced tongue, pierced cheek or a belly button ring?
(IF YOU ANSWERED 'YES' TO ANY OF THE ABOVE, DISCONTINUE APPLICATION AND LEAVE THE PREMISES IMMEDIATELY. I SUGGEST RUNNING.)
ESSAY SECTION:
In 50 words or less, what does 'LATE' mean to you?
__________________________________________________ ____________
__________________________________________________ ____________
In 50 words or less, what does 'DON'T TOUCH MY DAUGHTER' mean to you?
__________________________________________________ ____________
__________________________________________________ ____________
In 50 words or less, what does 'ABSTINENCE' mean to you?
__________________________________________________ ____________
__________________________________________________ ____________
REFERENCES SECTION:
Church you attend __________________________________________________ _
How often you attend ________________________________________________
When would be the best time to interview your:
father? _____________
mother? _____________
pastor? _____________
SHORT-ANSWER SECTION:
Answer by filling in the blank. Please answer freely, all answers
are confidential.
A: If I were shot, the last place I would want shot would be:
__________________________________________________ ____________
B: If I were beaten, the last bone I would want broken is my:
__________________________________________________ ____________
C: A woman's place is in the:
__________________________________________________ ____________
D: The one thing I hope this application does not ask me about is:
__________________________________________________ ____________
E. What do you want to do IF you grow up? ___________________________
__________________________________________________ ____________
__________________________________________________ ____________
F. When I meet a girl, the thing I always notice about her first is:
__________________________________________________ ____________
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, CRUCIFIXION, ELECTROCUTION, AND RED HOT POKERS.
__________________________________________________ _______
Applicant's Signature (that means sign your name, moron!)
_______________________________ ________________________________
Mother's Signature Father's Signature
_______________________________ ________________________________
Pastor/Priest/Rabbi State Representative/Congressman
Thank you for your interest, and it had better be genuine and non-sexual.
Please allow four to six years for processing.
You will be contacted in writing if you are approved. Please do not try to call or write (since you probably can't, and it would cause you injury). If your application is rejected, you will be notified by two gentleman wearing white ties carrying violin cases.
NAME_____________________________________ DATE OF BIRTH_____________
HEIGHT___________ WEIGHT____________ IQ__________ GPA_____________
SOCIAL SECURITY #_________________ DRIVERS LICENSE #________________
BOY SCOUT RANK AND BADGES__________________________________________
HOME ADDRESS_______________________ CITY/STATE___________ ZIP______
Do you have parents? ___Yes ___No
Is one male and the other female? ___Yes ___No
If No, explain: __________________________________________________ ___________
__________________________________________________ ___________________
Number of years they have been married ______________________________
If less than your age, explain
__________________________________________________ __________________
__________________________________________________ __________________
ACCESSORIES SECTION:
A. Do you own or have access to a van? __Yes __No
B. A truck with oversized tires? __Yes __No
C. A waterbed? __Yes __No
D. A pickup with a mattress in the back? __Yes __No
E. A tattoo? __Yes __No
F. Do you have an earring, nose ring, __Yes __No
pierced tongue, pierced cheek or a belly button ring?
(IF YOU ANSWERED 'YES' TO ANY OF THE ABOVE, DISCONTINUE APPLICATION AND LEAVE THE PREMISES IMMEDIATELY. I SUGGEST RUNNING.)
ESSAY SECTION:
In 50 words or less, what does 'LATE' mean to you?
__________________________________________________ ____________
__________________________________________________ ____________
In 50 words or less, what does 'DON'T TOUCH MY DAUGHTER' mean to you?
__________________________________________________ ____________
__________________________________________________ ____________
In 50 words or less, what does 'ABSTINENCE' mean to you?
__________________________________________________ ____________
__________________________________________________ ____________
REFERENCES SECTION:
Church you attend __________________________________________________ _
How often you attend ________________________________________________
When would be the best time to interview your:
father? _____________
mother? _____________
pastor? _____________
SHORT-ANSWER SECTION:
Answer by filling in the blank. Please answer freely, all answers
are confidential.
A: If I were shot, the last place I would want shot would be:
__________________________________________________ ____________
B: If I were beaten, the last bone I would want broken is my:
__________________________________________________ ____________
C: A woman's place is in the:
__________________________________________________ ____________
D: The one thing I hope this application does not ask me about is:
__________________________________________________ ____________
E. What do you want to do IF you grow up? ___________________________
__________________________________________________ ____________
__________________________________________________ ____________
F. When I meet a girl, the thing I always notice about her first is:
__________________________________________________ ____________
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, CRUCIFIXION, ELECTROCUTION, AND RED HOT POKERS.
__________________________________________________ _______
Applicant's Signature (that means sign your name, moron!)
_______________________________ ________________________________
Mother's Signature Father's Signature
_______________________________ ________________________________
Pastor/Priest/Rabbi State Representative/Congressman
Thank you for your interest, and it had better be genuine and non-sexual.
Please allow four to six years for processing.
You will be contacted in writing if you are approved. Please do not try to call or write (since you probably can't, and it would cause you injury). If your application is rejected, you will be notified by two gentleman wearing white ties carrying violin cases.
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