NAME:__________________________________________ DOB:___/___/___ HOME ADDRESS:_________________________________________________ CITY/STATE/ZIP:__________________________________________________ HEIGHT:______________ WEIGHT:____________ NATURAL HAIR COLOR:___________ PRESENT HAIR COLOR:____________ EYE COLOR:_________ BIRTHMARKS:________________________________ SCHOOL:_______________________________ GRADE:________________ IQ:________ GPA:_________ SOCIAL SECURITY #________________________________ DRIVER'S LICENSE #________________________________ BOY SCOUT RANK AND BADGES:___________________________________________
Do you live with your parents? Y N If NO, please explain:_____________________________________________ Number of years your parents have been married:_____ If less than your age, explain:_______________________________________
Do you own a van? Y N A truck with oversized tires? Y N A waterbed? Y N A pickup with a mattress in the back? Y N A condom? Y N Pornography? Y N Do you have an ear ring, nose ring, or a tattoo? Y N IF YOU ANSWERED YES TO ANY OF THE ABOVE, DISCONTINUE APPLICATION AND LEAVE PREMISES.
In 25 words or less, what does LATE mean to you? _______________________________________________________________________ In 25 words or less, what does ABSTINENCE mean to you? _______________________________________________________________________ In 25 words or less, what does DON"T TOUCH MY DAUGHTER, mean to you? _______________________________________________________________________
Church you attend:_______________________________________________________ How often do you attend?_________________________________________________ When would be the best time to interview your: Father?_______ Mother?_______ Bishop/Priest/Rabbi?_______ Parole Officer?________
Answer by filling in the blank. Please answer freely, all answers are confidential. A: If I were beaten, the last bone I would want broken is my: ____________________________________________________________ B: If I were shot, the last place I would want hit is my: ____________________________________________________________ C: A woman's place is:_________________________________________ D: The one thing I hope this application doesn't ask me about is: ____________________________________________________________ E: When I first meet a girl, the thing I notice about her first is: ____________________________________________________________NOTE: If answer E begins with T or A, discontinue. Leaving premises, 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?__________________________
Condoms come in packages of: (circle one)
A: 3
B: 6
C: 9
D: 12
E: All of the above
How do you know?____________________________________________
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, ELECTROCUTION, CHINESE WATER TORTURE,
RED HOT POKERS, AND/OR THE HILLARY CLINTON KISS
TORTURE.
_________________________________________________________/____________ Signature (that means sign your name) Date
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 call or write (or e-mail).
If your application is rejected, you will be notified by two gentlemen wearing black suits and white ties carrying violin cases (you may want to watch your back).
Have a day.