Application For Permission To Date My
Please be prepared to submit additional information e.g.
psychological profile, DNA samples and admission to polygraph
Name:______________________________________ Date of Birth
2.Height: __ft__in. Weight: ___Lbs. I.Q: __ GPA:
3.Social Security Number: ___-___-____ Drivers
License: State: _______ Number: _____________
address____________________ City: _____________
Scout Rank: _________________
fast can you run 40 yards: ____sec. Two Miles:
7.Church you attend: ___________________ How
50 words or less, Explan what "DONT TOUCH MY
DAUGHTER" means to you:
9. In 50
words or less, Explain what
"Late" means to you:
the following sentences:
a) If I were to be shot, the last place I
would want to be shot is in the __________.
b) If I were to be beaten, the last bone I
would want to have broken is ___________.
c) The one thing I hope this Application does
not as is________________________________________.
d) In the unfortunate event of my untimely
death, I would like my ashes scattered
e)My greatest fear
What do you want me be if you grow
you ever been fingerprinted? Yes___ No___
you have any identifying marks? e.g. birth marks,scars, tattoos
dentist is __________________________________
hereby swear that all the information supplied above is true and
correct to the best of my knowledge under penalty of Deah and or
you for your interest! Please allow 4-6 years for processing. You
will be contacted in writing if you are approved. Please do not
call, write or E-mail. Any attempts at contact during the
processing of this application could be hazardous to your health
and/or cause serious personal injury.