APPLICATION
FOR PERMISSION TO DATE MY DAUGHTER
This application must
be answered in full prior to permission being granted to date my daughter.
Remember all answers will be checked for valid responses. Please consult your
life insurance agent to verify that all beneficiaries are current and additional
coverage is applied for if needed prior to turning this application in.
Name: _____________________
Date of Birth: _________________
Home
Address: ____________________ City: ___________________
Prov:
_______________________ Postal: ______________________
SIN #:
________________________________
Driver
License #: ________________________________
Height:
________________________ Weight: ____________
I.Q.:
___________________ G.P.A.: ______________________
Boy Scout
Rank: _________________________
1.
Do you have one male and one female parent? (Yes / No)
If no, explain:
_____________________________________________________________
2.
Do you own a van? (Yes / No)
a
truck with over-sized tires? (Yes / No)
a
waterbed? (Yes / No)
(Note: if you
answered yes to any of #2, put down your pencil, discontinue application, and
leave premises)
3.
In
50 words or less, what does LATE mean to you?
4.
In 50 words or less, what does DON’T TOUCH MY DAUGHTER mean to you?
5. In 50 words or less, what does ABSTINENCE mean to you?
6.
Do you have an ear ring, nose ring, belly-button ring or tattoo? (Yes /
No)
(Note: if you answer
YES to any of #6, put down your pencil, discontinue application, and leave
premises).
7.
Do you attend church? (Yes / No)
How often do you
attend? ___________________
8. When would be the best time to interview your father, mother, priest/pastor? __________
9.
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 in my body I would want broken is my …
C.
A women’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 is her …
___________________________
(Note: If answer E
begins with “T” or “A”, put down your pencil, discontinue application,
and leave premises keeping your head low and running in serpentine fashion
is advised.)
10. 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 TORTURE, CRUCIFIXION,
ELECTROCUTION, CHINESE WATER TORTURE, AND RED-HOT POKERS.