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GENERAL INFORMATION: 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 parents? ___Yes ___No If “No”, explain: __________________________________________________________________________________________________________________________________Number of years they have been married ______________________________If less than your age, explain________________________________________________________________________________________________________________________________________ACCESSORIES SECTION: A. A woman's place is in the:______________________________________________________________2 of 5— Application for Permission to Date my Daughter —D. ____________________________________________________________________________________________________________________________REFERENCES SECTION: Church you attend ___________________________________________________How often you attend ________________________________________________When would be the best time to interview your: Father? Please answer freely, all answers are confidential. If I were shot, the last place I would want shot would be:______________________________________________________________B.Rule Four: I'm sure you've been told that in today's world, sex without utilizing a "barrier method" of some kind can kill you.

Name __________________________________ Date of Birth _______________Height _________ Weight ___________ I. If you cannot keep your eyes or hands off of my daughter's body, I will remove them.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 white ties carrying violin cases.Below is the text from the form, however, I have created a PDF version of it that is probably more useful. Please do not try to call or write (since you probably can’t, and it would cause you injury).The PDF version –NOTE: This application will be incomplete and rejected unless accompanied by a complete financial statement, job history, lineage, and current medical report from your doctor. If your application is rejected, you will be notified by two gentleman wearing white ties carrying violin cases.

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