Application¬ For Permission To Date My Daughter
Note: Please be prepared to submit additional information- e.g. psychological profile, DNA sample, and submission to polygraph exam.
1. Name:___________________________________ Date of Birth:____/____/_______
2. Height:____ft. ____in. Weight:_______lbs. I.Q.:________ GPA:_________
3. Social Security #:_____-______-_____ Driver’s License: State____ Number_________
4. Home Address: _________________________ City:________________ State:_______
5. Boy Scout Rank:__________________________
6. How fast can you run 40 yards?: ____sec. Two Miles?: _____min.
7. Church you attend: __________________________ How often?:_________________
8. In 50 words or less, Explain what “DON’T TOUCH MY DAUGHTER” means to you.
________________________________________________________________________________________________________________________________________________
9. In 50 words or less, Explain what “Late” means to you.
________________________________________________________________________________________________________________________________________________
10. Complete 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 broken is _______________
c. The only thing I hope this Application does not ask is _______________________________________________________________
d. In the unfortunate event of my untimely death, I would like my ashes scattered _______________________________________________________________
e. My greatest fear is _______________________________________________
11. What do you want to be if you grow up? _______________________________________
12. Have you ever been fingerprinted? Yes______ No______
13. Do you have any Identifying marks? e.g. birth marks, scars, tattoos- Yes_____ No_____
(if yes please explain and give location) _______________________________________
________________________________________________________________________
14. My Dentist is ________________________ City____________________ State________
I hereby swear that all the information supplied above is true and correct to the best of my knowledge under penalty of Death or Dismemberment.
Signed: ______________________________________

Thank you for your interest! Please allow 4 to 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.