APPLICATION FOR PERMISSION TO DATE MY DAUGHTER 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. 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 Is one male and the other female? ___Yes ___No If No, explain: ______________________________________________________________ Number of years they have been married ______________________________ If less than your age, explain ______________________________________________________________ ______________________________________________________________ ACCESSORIES SECTION: A. Do you own or have access to a van? __Yes __No B. A truck with oversized tires? __Yes __No C. A waterbed? __Yes __No D. A pickup with a mattress in the back? __Yes __No E. A tattoo? __Yes __No F. Do you have an earring, nose ring, __Yes __No pierced tongue, pierced cheek or a belly button ring? (IF YOU ANSWERED "YES" TO ANY OF THE ABOVE, DISCONTINUE APPLICATION AND LEAVE PREMISES IMMEDIATELY. I SUGGEST RUNNING.) ESSAY SECTION: 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? ______________________________________________________________ ______________________________________________________________ REFERENCES SECTION: Church you attend ___________________________________________________ How often you attend ________________________________________________ When would be the best time to interview your: father? _____________ mother? _____________ pastor? _____________ SHORT-ANSWER SECTION: 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. What do you want to do IF you grow up? ___________________________ ______________________________________________________________ ______________________________________________________________ F. When I meet a girl, the thing I always notice about her first is: ______________________________________________________________ F. What is the current going rate of a hotel room? __________________ 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. _________________________________________________________ Applicant's Signature (that means sign your name, moron!) _______________________________ ________________________________ Mother's Signature Father's Signature _______________________________ ________________________________ Pastor/Priest/Rabbi State Representative/Congressman Thank you for your interest, and it had better be genuine and non-sexual. 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 white ties carrying violin cases. (you might watch your back)
Author unknown. One person says that this “was written by John Sherbondy
of Council Bluffs, Iowa. It appeared in his wifes column in the Nonpareil
Newspaper called Kippies Corner.” (abt. 1993) I’ve tried to contact
Mr. Sherbondy to confirm but haven’t succeeded yet.