Note: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, driving record, family lineage and current certified medical report (including drug test) from your doctor.

Name _________________________________ Date of Birth _________________________

Height ______ Weight _______ I.Q. ______ G.P.A ______ S.A.T. _______ A.C.T. ________

Social Security # ________________________ Authorizing permission to run a credit bureau

Drivers License # ________________________ Authorizing permission to run driving record

Highest Rank reached in Boy Scouts _____________________________________________

Home Address _______________________________________________________________

Email Address _______________________________________________________________

If your personal email address includes profanity (Example:, please explain its’ meaning:


Do you have one Male and one Female parent?  If No, Explain_________________________


Number of years your parents have been married ___________________________________

Do you own a van? ______ A truck with oversized tires? ________ A waterbed? __________

Do you have a tongue ring, nose ring, belly ring, nipple ring or a tattoo?  ______ If “Yes” please 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?  _________________________



Name of Church you attend ________________________ How often ___________________

When would be the best time to interview the following people?

Your Father ___________________ AM or PM, Best Contact Phone _______________

Your Mother __________________ AM or PM, Best Contact Phone _______________

Your Minister __________________ AM or PM, Best Contact Phone _______________

Answer by filling in the blank.  Please answer freely.  ALL answers are confidential (That means I won’t tell anyone).

If you were shot, the last place on your body you would want wounded would be:


If your were beaten, the last bone you would want broken would be:


“A woman’s place is in the”:


One thing I hope this application does not ask about me is:


When I first meet a girl, the first thing I notice about her is:


Note: If the answer to E begins with “T” or “A”, discontinue.  Leave premises keeping your head low, running in a zigzag fashion.

What do you want to be when you grow up (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 Red Ant torture, Electrocution, Chinese Water Torture, and Red Hot Poker Treatment.


Signature (that means your name in cursive)

Thank you for your interest in my daughter.  Please allow 4 to 6 YEARS for processing.  You will be notified in writing if you are approved.  Please DO NOT try to call, email or write.  If you do attempt any communication before your application is approved, automatic disqualification will result.  If you application is rejected, two men wearing dark suits and sunglasses will notify you.

Do you still want to date my Daughter?

_________ Yes, please submit my application (I agree to the attached “Rules.”)

_________ No, I have the wrong house, I am terribly sorry to disturb you.

Accompanying Rules for dating my Daughter:

  1. If you pull into my driveway and honk, I will assume that you are delivering something, because you are not picking anything up.
  2. You do not stare at my daughter.  You may glance at her, so long as you do not peer below her neck.  If you cannot keep your eyes or hands off my daughter, I will remove them.
  3. I am aware that it is considered fashionable for boys your age to wear their trousers so loosely that they appear to be falling off their hips.  Please don’t take this personally, but you and your friends are complete idiots.  Still, I want to be open-minded.  So, if you come to the door with your underwear showing I will take my electric nail gun and fasten you trousers securely in place to your waist to ensure that during the course of your date your trousers do not come off.
  4. I’m sure you have been told that in today’s world, sex without some sort of “barrier method” of some kind can kill you.  Let me elaborate.  When it comes to sex, I am the barrier, and I will kill you.
  5. It is usually understood that in order for us to get to know each other, we should talk about sports, politics and other current affairs.  PLEASE DO NOT DO THIS.  The only information I require is what time I can expect my daughter to be home safely, and the only acceptable answer is “Early.”
  6. I have no doubt that you are a popular guy, with many opportunities to date and flirt with other girls.  This is fine with me as long as it is okay with my daughter.  Otherwise, once you have gone out with my little princess, you will continue to date no one but her until she is finished with you.
  7. If you make my little girl cry, I will make you cry.
  8. As you are waiting in my front entry for my daughter to appear, and some significant time goes by, do not sigh or fidget.  If you want to be on time, you should not date my daughter.  My daughter is putting on her makeup, fixing her beautiful hair and choosing an outfit that will pass my inspection.  Instead of standing there, please do something useful, like mowing my yard, taking out my trash, or changing the oil in my car.
  9. Do not lie to me.  I may appear to be advancing in age and intelligence, but I am all knowing when it comes to my daughter.  I have a shotgun, a shovel and some extra land.  Do not mess with me.
  10. The following places are not appropriate for a date with my daughter:
  • Places where there are beds, sofas, or anything softer than a wooden stool.
  • Places where there are no parents, policemen, or pastors in eyesight.
  • Places where there is no presence of light.
  • Places it is warm enough to induce my daughter to wear shorts, tank tops or anything other than overalls, a sweater and a goose down parka zipped to the top.
  • Movies with romantic themes.  Movies with chain saws are okay.
  • Hockey games are okay.
  • Retirement homes are best.

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