Application to Date My Daughter

NOTE: This application will be considered incomplete and rejected unless accompanied by a complete financial statement, job history, family lineage, and current medical report from your doctor.

— SECTION 1 : GENERAL INFORMATION —

• FULL NAME ___________________________________________________
• NICKNAMES ___________________________________________________
• “STREET” NAMES _________________________________________________
• Explain why you have these nicknames _____________________________________________________________________________________________________________________________________________________________________

• AGE ______ DATE OF BIRTH _________________
• Is your date of birth within 2 years of my daughter’s? ___Yes __ No

• HEIGHT ______________
• WEIGHT ______________
• IQ _____________ GPA _____________
• SOCIAL SECURITY # _________________
• DRIVERS LICENSE # _____________________
• SELECTIVE SERVICE #____________________
• Boy Scout rank and highest badges earned ____________________________________________
• HOME ADDRESS ___________________________
• CITY/STATE ______________ ZIP ___________

Do you have 2 parents? ___ Yes ___ No
Is one male and the other female? ___ Yes ___ No
If Not, explain:__________________________________________

Are your parents married? ____ Yes ___ No
Number of years they have been married _______
If less than your age, explain ______________________________________________

Where do you live?

• ___ with my parents
• ___ in a dorm room
• ___ with friends
• ___ have my own place
• ___ with my ex
• ___ wherever, dude

— SECTION 2: LIFESTYLE —

Do you own or have access to:
   a van? ___ Yes ___ No
   a truck with oversized tires? ___ Yes ___ No
   a waterbed? ___ Yes ___ No

Do you have:
   a tattoo? ___ Yes ___ No
   an earring, nose ring or any other piercing? ___ Yes ___ No
   (pierced tongue, pierced nipples or an ear gauge?)

Do you:
   Use tobacco? ___ Yes ___ No
   Smoke weed? ___ Yes ___ No
   Drink alcohol? ___ Yes ___ No
   Huff? ___ Yes ___ No
   Take drugs? ___ Yes ___ No
   Have sex regularly? ___ Yes ___ No

NOTE: IF YOU ANSWERED ‘YES’ TO ANY OF THE ABOVE QUESTIONS, YOU MAY DISCONTINUE YOUR APPLICATION AND LEAVE PREMISES QUICKLY AND IMMEDIATELY.

— SECTION 3: ESSAY questions —

Describe in 50 words or less, what ‘LATE’ means to you. ____________________________________________________________________________________________________________________________________________________

Describe in 50 words or less, what ‘DON’T TOUCH MY DAUGHTER’ means to you.

____________________________________________________________________________________________________________________________________________________

Describe in 50 words or less, what ‘ABSTINENCE’ means to you.

____________________________________________________________________________________________________________________________________________________

— SECTION 4: REFERENCES —

Church you attend ______________________________________________________

How often do you attend? ______________________________________________________

When would be the best time to meet your:

father? _____________

mother? _____________

doctor? _____________

Youth minister?____________

teachers?_______________