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: _____ I.Q.: _____ GPA: _____
SSN: ___-__-____ DL#: _________
BOY SCOUT RANK AND BADGES: ________________________
HOME ADDRESS: _____________CITY/ST: _______ ZIP: _____
Do you have ONE male and ONE female parent? _______________
If no, please explain: ___________________________________
Number of years parents have been married: _________________
If less than your age, explain: ____________________________
Do you own:
a van? _____
a truck with over sized tires? _____
a waterbed? _____
a pickup with a mattress in the back? _____
Do you have an earring, nose ring, or belly button ring? _____
a tattoo? _____
(If yes to the above, DISCONTINUE APPLICATION AND LEAVE PREMISES)
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?
Church attend: _______________ How often? _________
When would be a good time to interview your father, mother, and pastor?
Answer by filling in the blank. Please answer freely, all answer are confidential. (That means I won't tell anyone EVER!)
A. If I were shot, the last place I would want to be shot would be __________
B. If I were beaten, the last bone 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 is ________________
E. When I first meet a girl the thing I notice about her first is______________
Note: If answer E begins with a T or A, discontinue, leaving the premises while keeping your head low and running in a serpentine fashion is advised.
What do you want to do IF you grow up?
What is the current rate for a hotel room?
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, CHINESE WATER TORTURE, DECAPITATION, AND RED HOT POKERS
Signature (that means sign your name above)
Thank you for your interest. 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 injury). If your application is rejected, you will BE NOTIFIED BY TWO GENTLEMEN WEARING WHITE TIES ANS CARRYING VIOLIN CASES.