1.  Name :__________________________________________________ Date of Birth :_________________
2. Height :___________________________ Weight :_______________________ GPA :________________
3. Social Sec. #_______________________ Drivers license #______________________________________
4. Boy Scout Rank :__________________________
5. Home  address :____________________________ City/ State____________________________________
6. Do you have one male and one female parent ? Yes _______ No _______
7. If no,  explain :_________________________________________________________________________
8. Number of years parents married :__________________________________________________________
9. Do you own a van ?______ A truck with oversized tires ?______ A water bed ?_______
10. Do you have an earring , nose ring , belly-button ring ?______ A tattoo ?_______
(If yes to any of #9 or #10, Discontinue  application and leave premises ...
11. In ten words or less, what does LATE mean to you ?___________________________________________
12. In ten words or less, what does Abstinence mean to you ?______________________________________
13. In ten words or less, what does DON'T TOUCH MY DAUGHTER mean to you ?___________________
_______________________________________________________________________________________
14. Church you attend :_________________________________ How often you attend :_______________
15. When would be the best time to interview your Father, Mother, And Minister ? ___________________
16. What would you want to be IF you grew up ? _______________________________________________

Answer by filling in the blanks. Please answer freely - all answers are confidential
(that I won't tell anyone - ever- I promise).

If I were shot, the last place on my body I would want wounded is in the __________________________

If I were beaten the last bone I would want broken is my ________________________________________
The one thing I hope this application does not ask me about is ___________________________________

When I first meet a girl, the thing I notice about her first is_______________________________________
(Note: If answer begins with T or A, discontinue and leave premises: Keeping your head low and running in
a serpentine fashion is advised. )

I SWEAR THAT THE INFORMATION SUPPLIED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE UNDER PENALTY OF:  NATIVE AMERICAN ANT TORTURE, ELECTROCUTION,
CHINESE WATER TORTURE,  RED HOT POKERS, DEATH, AND DISMEMBERMENT.

Signature (that means your name, moron)______________________________________________________

Thank you for your interest. Please allow 4 to 6 weeks for processing. You will be contacted in writing if
you are approved. Please do not attempt to call or write. If your  application is rejected you will be
notified by two gentlemen  wearing white coats and carrying a violin case.

APPLICANT'S  RIGHT THUMB PRINT IN BLOOD