NOTE: This application will be incomplete and rejected unless
accompanied by a complete financial statement, school history, job
history, ancestral lineage, DMV printout, and a current medical
report from your doctor.
NAME______________________________________
DATE OF BIRTH______________
HEIGHT____________ WEIGHT_____________ IQ__________
GPA_____________
SOCIAL SECURITY #___________________
DRIVERS LICENSE #________________
BOY SCOUT RANK AND
BADGES______________________________________________
HOME ADDRESS__________________________ CITY/STATE___________
ZIP_____
Do you have ONE male and ONE female parent?
___________________________
If NO, please explain
_________________________________________________
_________________________________________________
Number of years they have been married
________________________________
If less than your age, explain
_________________________________________________
_________________________________________________
Do you own a van? _____________
A truck with oversized tires?___________
A waterbed?_____________
A pickup with a mattress in the back?__________
A condom?_______________
Pornography?_______________
Do you have an earring, nose ring, or a belly button ring? ______________
A tattoo?_____________
(IF YES TO ANY OF 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 you attend:
______________________________________________________
How often you attend:
___________________________________________________
When would be the best time to interview your:
father? _____________ priest? _______________
mother? _____________ parole officer? _______
Answer by filling in the blank. Please answer freely, all answers
are confidential.
A: If I were shot, the last place I would want shot would be:
_____________________________________________________________________
B: If I were beaten, the last bone I would want broken is my:
_____________________________________________________________________
C: A woman's place is in the:________________________________________
D: The one thing I hope this application does not 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 going rate of 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, CRUCIFIXION, ELECTROCUTION, CHINESE
WATER TORTURE, RED HOT POKERS, AND HILLARY CLINTON KISS TORTURE.
_______________________________________
Signature (that means sign your name, moron)
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
you injury). If your application is rejected, you will be notified by
two gentleman wearing black shirts and white ties carrying violin
cases (you might want to watch your back).
Have a nice day.